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Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of radiation therapy in the management of progressive and recurrent glioblastoma in adults

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Abstract

Target population

These recommendations apply to adult patients (18 years of age and above) with progressive/recurrent glioblastoma multiforme (pGBM) after first line combined multimodality treatment.

Question

Can re-irradiation (by using conventional radiotherapy, fractionated radiosurgery, or single fraction radiosurgery) be used in patients with pGBM after the first adjuvant combined multimodality treatment with radiation and chemotherapy?

Recommendation

Level III: When the target tumor is amenable for additional radiation, re-irradiation is recommended as it provides improved local tumor control, as measured by best imaging response. Such re-irradiation can take the form of conventional fractionation radiotherapy, fractionated radiosurgery, or single fraction radiosurgery. Level III: Re-Irradiation is recommended in order to maintain or improve a patient’s neurological status and quality of life prior to any further tumor progression.

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Data availability

All authors have ensured all data and materials as well as software applications or custom code supports their published claims and comply with field standards.

Abbreviations

GBM:

Glioblastoma

PFS:

Progression free survival

OS:

Overall survival

RT:

Radiation therapy

SRS:

Stereotactic radio surgery

pGBM:

Progressive/recurrent GBM

TMZ:

Temozolomide

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Acknowledgements

The guidelines task force would like to acknowledge the Congress of Neurological Surgeons Guidelines Committee for their contributions throughout the development of the guideline, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee for their review, comments, and suggestions throughout peer review, as well as the contributions of Trish Rehring, MPH, CHES, Senior Manager of Clinical Practice Guidelines for the CNS, and Mary Bodach, MLIS, from the Congress of Neurological Surgeons Guidelines Office for organizational assistance and reference librarian services, respectively as well as Jeremy Kupsco, PhD, Informationist, Emory University, for their valuable input as Medical Research Librarians. Throughout the review process, the reviewers and authors were blinded from one another. At this time the guidelines task force would like to acknowledge the following individual peer reviewers for their contributions.

Disclaimer of liability

This clinical systematic review and evidence-based guideline was developed by a physician volunteer task force as an educational tool that reflects the current state of knowledge at the time of completion. The presentations are designed to provide an accurate review of the subject matter covered. This guideline is disseminated with the understanding that the recommendations by the authors and consultants who have collaborated in its development are not meant to replace the individualized care and treatment advice from a patient's physician(s). If medical advice or assistance is required, the services of a physician should be sought. The proposals contained in this guideline may not be suitable for use in all circumstances. The choice to implement any particular recommendation contained in this guideline must be made by a managing physician in light of the situation in each particular patient and on the basis of existing resources.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Inova Health System, Fairfax, VA, USA

    Mateo Ziu, Sharad Goyal & Jeffrey J. Olson

  2. Radiation Oncology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Mateo Ziu, Sharad Goyal & Jeffrey J. Olson

  3. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA

    Mateo Ziu, Sharad Goyal & Jeffrey J. Olson

  4. Department of Neurosurgery, Inova Neurosciences, 3300 Gallows Rd, Falls Church, VA, 22042, USA

    Mateo Ziu

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  1. Mateo Ziu
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All authors listed on this publication agree with the content included and give explicit consent to the submission of this publication. The authors obtained consent from the responsible authorities at the institute/organization where the work has been carried out, before the work was submitted. All authors whose names appear on the submission: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Mateo Ziu.

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Conflict of interest

All Guideline Task Force members were required to disclose all potential COIs prior to beginning work on the guideline, using the COI disclosure form of the AANS/CNS Joint Guidelines Review Committee. The CNS Guidelines Committee and Guideline Task Force Chair reviewed the disclosures and either approved or disapproved the nomination and participation on the task force. The CNS Guidelines Committee and Guideline Task Force Chair may approve nominations of task force members with possible conflicts and restrict the writing, reviewing, and/or voting privileges of that person to topics that are unrelated to the possible COIs. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this series of articles.

Disclosures

These guidelines were funded exclusively by the Congress of Neurological Surgeons (CNS) and the Joint Section on Tumors, which received no funding from outside commercial sources to support the development of this document.

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Sponsors: Congress of Neurological Surgeons (CNS) and the Section on Tumors.

Endorsement: Reviewed for evidence-based integrity and endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

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Ziu, M., Goyal, S. & Olson, J.J. Congress of Neurological Surgeons systematic review and evidence-based guidelines update on the role of radiation therapy in the management of progressive and recurrent glioblastoma in adults. J Neurooncol 158, 255–264 (2022). https://doi.org/10.1007/s11060-021-03857-w

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