Glioblastoma and diffuse astrocytoma, IDH wildtype

Jennie W Taylor MD MPH (

Dr. Taylor of University of California, San Francisco received research grand funding from Agios, BMS, and Abbvie.

)
Rimas V Lukas MD, editor. (

Dr. Lukas of Northwestern University Feinberg School of Medicine received honorariums from AbbVie and Novocure for speaking engagements, from Eisai for consulting work, and from Monetris as an advisory board member.

)
Originally released January 16, 2020; expires January 16, 2023

This article includes discussion of diffuse astrocytomas, IDH wildtype, with particular focus on glioblastoma, IDH wildtype, including classification and treatment.

Overview

Diffuse astrocytomas, IDH wildtype, encompass a variety of histologies, with glioblastomas being the most common and most aggressive subtype. This review focuses on diagnosis and management of adult glioblastoma, IDH wildtype, and discusses other histologies included in the 2016 World Health Organization classification of IDH wildtype astrocytoma.

Key points

 

• Glioblastoma, IDH wildtype, is the most common malignant primary brain tumor with an often aggressive clinical course.

 

• Treatment of glioblastoma, IDH wildtype, is multimodal and includes maximal safe surgical resection, fractionated radiation, chemotherapy, and tumor-treating fields.

 

• Age and performance status at diagnosis in glioblastoma may influence optimal dosing of radiation and chemotherapy.

 

• Molecular testing should be considered in diffuse astrocytomas that are IDH1 R132H wildtype by immunohistochemistry with high clinical or radiologic suspicion for glioblastoma to evaluate hallmark features of molecular glioblastoma.

 

• Diffuse astrocytomas, IDH wildtype, also include diffuse midline gliomas with H3 K27 mutation, pleomorphic xanthoastrocytomas, and others and are defined by other molecular signatures and are not discussed in detail in this review.

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