title: Radiation Therapy for Glioblastoma: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Guideline.
abstract: Purpose The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on radiation therapy for glioblastoma. Because of its relevance to the ASCO membership, ASCO reviewed the guideline and applied a set of procedures and policies used to critically examine guidelines developed by other organizations. Methods The ASTRO guideline on radiation therapy for glioblastoma was reviewed for developmental rigor by methodologists. An ASCO endorsement panel updated the literature search and reviewed the content and recommendations. Results The ASCO endorsement panel determined that the recommendations from the ASTRO guideline, published in 2016, are clear, thorough, and based on current scientific evidence. ASCO endorsed the ASTRO guideline on radiation therapy for glioblastoma and added qualifying statements. Recommendations Partial-brain fractionated radiotherapy with concurrent and adjuvant temozolomide is the standard of care after biopsy or resection of newly diagnosed glioblastoma in patients up to 70 years of age. Hypofractionated radiotherapy for elderly patients with fair to good performance status is appropriate. The addition of concurrent and adjuvant temozolomide to hypofractionated radiotherapy seems to be safe and efficacious without impairing quality of life for elderly patients with good performance status. Reasonable options for patients with poor performance status include hypofractionated radiotherapy alone, temozolomide alone, or best supportive care. Focal reirradiation represents an option for select patients with recurrent glioblastoma, although this is not supported by prospective randomized evidence. Additional information is available at www.asco.org/glioblastoma-radiotherapy-endorsement and www.asco.org/guidelineswiki .
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Sulman
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Nofisat
authors.initials: N
authors.lastname: Ismaila
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Terri S
authors.initials: TS
authors.lastname: Armstrong
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Christina
authors.initials: C
authors.lastname: Tsien
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Tracy T
authors.initials: TT
authors.lastname: Batchelor
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Tim
authors.initials: T
authors.lastname: Cloughesy
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Evanthia
authors.initials: E
authors.lastname: Galanis
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Vinai
authors.initials: V
authors.lastname: Gondi
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Mary
authors.initials: M
authors.lastname: Lovely
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Minesh
authors.initials: M
authors.lastname: Mehta
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Mumber
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sloan
authors.affiliation: Erik P. Sulman and Terri S. Armstrong, MD Anderson Cancer Center; Terri S. Armstrong, University of Texas Health Science Center, Houston, TX; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria, VA; Christina Tsien, Washington University Physicians, St Louis, MO; Tracy T. Batchelor, Massachusetts General Hospital, Boston, MA; Tim Cloughesy, University of California, Los Angeles, Los Angeles; Mary Lovely and Susan M. Chang, University of California, San Francisco, San Francisco, CA; Evanthia Galanis, Mayo Clinic, Rochester, MN; Mark Gilbert, National Cancer Institute, Bethesda; Minesh Mehta, University of Maryland School of Medicine, Baltimore, MD; Vinai Gondi, Northwestern Medicine Cancer Center, Warrenville, IL; Matthew P. Mumber, Harbin Clinic Radiation Oncology, Rome, GA; and Andrew Sloan, University Hospitals Cleveland Medical Center, Cleveland, OH.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chang
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000592:standards*; D032921:Consensus; D016371:Cranial Irradiation / Q000009:adverse effects / Q000592:standards*; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine / Q000592:standards; D005909:Glioblastoma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D018579:Patient Selection; D000077204:Temozolomide; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide