NCCN Guidelines Insights: Central Nervous System Cancers, Version 1.2017

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  • 1 From University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; Yale Cancer Center/Smilow Cancer Hospital; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UCSF Helen Diller Family Comprehensive Cancer Center; Roswell Park Cancer Institute; Moffitt Cancer Center; UC San Diego Moores Cancer Center; University of Wisconsin Carbone Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Massachusetts General Hospital Cancer Center; Vanderbilt-Ingram Cancer Center; Mayo Clinic Cancer Center; Stanford Cancer Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Duke Cancer Institute; University of Washington/Seattle Cancer Care Alliance; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; University of Colorado Cancer Center; Fred & Pamela Buffet Cancer Center; Huntsman Cancer Institute at the University of Utah; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Fox Chase Cancer Center; Dana-Farber Cancer Institute/Brigham and Women's Cancer Center; American Brain Tumor Association; and National Comprehensive Cancer Network.
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For many years, the diagnosis and classification of gliomas have been based on histology. Although studies including large populations of patients demonstrated the prognostic value of histologic phenotype, variability in outcomes within histologic groups limited the utility of this system. Nonetheless, histology was the only proven and widely accessible tool available at the time, thus it was used for clinical trial entry criteria, and therefore determined the recommended treatment options. Research to identify molecular changes that underlie glioma progression has led to the discovery of molecular features that have greater diagnostic and prognostic value than histology. Analyses of these molecular markers across populations from randomized clinical trials have shown that some of these markers are also predictive of response to specific types of treatment, which has prompted significant changes to the recommended treatment options for grade III (anaplastic) gliomas.

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