ASTRO Releases New Guidelines for Treating Aggressive Brain Tumors with Radiation Therapy

The American Society for Radiation Oncology (ASTRO) has issued new clinical guidelines on the use of radiation therapy for adult patients with World Health Organization (WHO) grade 4 diffuse gliomas—among the most common and aggressive forms of primary brain tumors. Published in the journal Practical Radiation Oncology, the updated recommendations replace ASTRO’s 2016 guidelines for treating glioblastoma.

Glioblastomas, reclassified by the WHO in 2021 as grade 4 adult-type diffuse gliomas, make up nearly half of all malignant brain tumors in adults. Around 10,000 Americans are diagnosed with these tumors each year. Known for their rapid growth and infiltration into surrounding brain tissue, glioblastomas have a poor prognosis. However, advancements in surgery, radiation, and systemic therapies have led to improvements in both survival and quality of life. Because these tumors are rarely fully removable through surgery, radiation therapy remains a central part of treatment.

The 2021 WHO reclassification marked a shift in the diagnosis and grading of gliomas, emphasizing molecular markers in addition to traditional histology. ASTRO’s revised guideline reflects this updated approach, incorporating advanced imaging techniques and the latest treatment options to better guide patient care.

Joseph A. Bovi, MD, chair of the guideline task force and a radiation oncologist at ThedaCare Regional Cancer Center in Appleton, Wisconsin stated, “As oncologists, high-grade gliomas are among the most challenging cancers we see, and radiation therapy plays a vital role in improving outcomes for these patients. This guideline brings together the best evidence across multiple disciplines to support coordinated care that includes surgery, radiation therapy, systemic therapies, alternating electric field therapy and supportive care."

“Our goal was to equip clinicians with a clear, robust framework for shared decision-making with their patients, while also highlighting areas where research is needed to move the field forward,” said Debra Nana Yeboa, MD, vice chair of the guideline task force and an associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston. “Progress in personalized medicine, biomarker discovery, and advanced treatment techniques could help us change outcomes for patients, particularly those in underserved populations.”