Initial Treatment Approach for High-Grade Glioma Brain Tumor

Diagnostic Confirmation

Histological diagnosis is mandatory and should include sufficient tissue for molecular tumor characterization 2
Key molecular markers to determine include MGMT promoter methylation status, IDH mutations, and 1p/19q co-deletions 2, 3

Attempt maximal tumor resection provided neurological function is not compromised, as recommended by the European Society for Medical Oncology 1, 4
When microsurgical resection is not safely feasible, a biopsy should be performed, according to the National Comprehensive Cancer Network 1
Fluorescent marking of the tumor using 5-amino-laevulinic acid (5-ALA) during surgery improves complete resection rates and progression-free survival, as suggested by the American Association of Neurological Surgeons 1

For elderly patients (>65 years), hypo-fractionated radiotherapy is preferred over standard fractionation, as recommended by the International Society of Geriatric Oncology 1
MGMT promoter methylation status guides treatment choice: methylated MGMT may consider TMZ chemotherapy alone, while unmethylated MGMT prefers hypo-fractionated radiotherapy, according to the European Organisation for Research and Treatment of Cancer 1, 2

Lower tumor grade, younger age (<50 years), good performance status, intact neurological function, and radical tumor resection are favorable prognostic factors, as identified by the American Brain Tumor Association 6
Molecular markers provide additional prognostic information, including IDH mutations, 1p/19q co-deletions, and MGMT promoter methylation, as reported by the Society for Neuro-Oncology 3

Clinical evaluation with attention to neurological function, seizures, and corticosteroid use, as recommended by the European Society for Medical Oncology 5
Taper off steroid use as early as possible, and monitor for venous thrombotic events, which occur frequently in patients with residual or recurrent tumors, according to the National Comprehensive Cancer Network 5
MRI every 3-4 months is standard practice outside clinical trials, as suggested by the American College of Radiology 5