Treatment of diffuse astrocytoma (IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2) with favorable prognostic factors after surgery — when radiation and chemotherapy have been deferred
This protocol applies to a specific subset of low-grade diffuse glioma: astrocytoma that is IDH-mutant and 1p19q non-codeleted, classified as CNS WHO grade 2, in patients who have undergone one or more surgeries and for whom radiation therapy and chemotherapy have been or can be deferred.
Deferral of upfront radiation and chemotherapy is appropriate where favorable prognostic factors are present — such as complete resection or younger age — or where concerns about short- and long-term treatment toxicity are relevant given the natural history of this disease. This pathway does not apply to patients who are pregnant, breast feeding, or seeking pregnancy.
Treatment approach
When treatment is indicated, evidence supports a specific combination of radiation therapy together with adjuvant chemotherapy.
Full regimen, agent selection, and sequencing are in the complete protocol →
References
DOI: 10.1200/JCO-25-00250
- In astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2, initial radiation therapy and chemotherapy (with temozolomide or PCV) may be deferred until radiographic or symptomatic progression in some people with favorable prognostic factors (eg, complete resection, younger age) or concerns about short- and long-term toxicity given the natural history of the disease.
- People with astrocytoma, IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2 (low grade diffuse glioma) should be offered radiation therapy with adjuvant chemotherapy (temozolomide or PCV) (Evidence quality: Moderate; Strength of recommendation: Strong)
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