New Guidelines for Managing Grade 4 Diffuse Glioma

In a recent clinical practice guideline published in Practical Radiation Oncology on June 25, 2025, the American Society for Radiation Oncology provided updated recommendations for the treatment of World Health Organization (WHO) grade 4 adult-type diffuse glioma. This complex and aggressive brain tumor requires a multidisciplinary approach, and these new guidelines aim to optimize management strategies, particularly focusing on radiation therapy (RT) and adjunct therapies.

Authored by Dr. Debra Nana Yeboa from the University of Texas MD Anderson Cancer Center, the guidelines emphasize that the standard of care for eligible patients involves concurrent RT combined with temozolomide chemotherapy, followed by adjuvant temozolomide. For patients with specific molecular and pathological features, this combined approach is recommended after maximum safe surgical resection and proper prognostic evaluation. Additionally, the incorporation of alternating electric field therapy, also known as tumor-treating fields, is conditionally advised to enhance treatment efficacy.

For elderly patients or those who are frail, the guidelines suggest hypofractionated radiation therapy concurrently with temozolomide, considering individual patient health status. Supportive and palliative care are also conditionally recommended for those with significant frailty, with a focus on quality of life. In cases of tumor recurrence, after confirmation with advanced imaging or pathology, reirradiation—possibly combined with systemic therapies—can be considered on a case-by-case basis.

The guidelines also highlight the importance of addressing health disparities in this patient population. Efforts to improve clinical trial enrollment among underserved groups are crucial to advancing treatment outcomes for all patients.

Overall, these updated recommendations aim to provide clinicians with a clear framework for shared decision-making, while identifying key research areas needed to improve future therapeutic options.

Source: Medical Xpress