Weller and colleagues proposed the new European Association for
Neuro-Oncology (EANO) guide lines for adult gliomas.
have to be congratulated for their efforts in building
recommendations based on the 2016 revision of the WHO
classification, translating the integrated histo molecular
diagnosis into algorithmic decision making.
confirm that maximal safe surgical resection in high-volume
specialist centres has to be proposed whenever feasible,
independent of the grade of malignancy and the histomolecular
several important concepts that are disregarded in this paper
would deserve further comment.
there is no reference to radiological growth rate, which has been
shown to be an independent prognostic factor of overall survival
for diffuse low-grade gliomas, regardless of the molecular status
the role of surgery is presented in an ambiguous manner.
authors claim that “a large residual tumour volume after
surgery is a negative prognostic factor, but it remains uncertain
whether extent of resection truly matters, or whether resectable
tumours have a different biology associated with a less aggressive
course of disease.”
Considering the recent evidence
about the survival benefit of increased extent of resection, this
statement, which is in itself inconsistent, cannot be defended in
For example, in diffuse low-grade gliomas, two
randomised-like studies[4,5] have provided indisputable
conclusions about the relationship between improved survival and
extent of resection.
Moreover, this survival benefit still
persists after adjusting for molecular markers.
but not least, although it is stated that “quality of life
is a high priority to patients and carers”, there is no
mention of cognitive and quality of life assessments as a general
Glioma progression, seizures, antiepileptic
medication, and oncological adjuvant treatments directly affect
patients’ cognition, which in turn affects their quality of
Clinicians in charge of patients with glioma should
always keep in mind oncological and functional aspects—two
intricate but distinct facets of this disease.
guidelines appear to focus exclusively on survival curves, whereas
“survival with preserved quality of life” appears to
be of greater importance.
Clinicians are treating
individual patients each with specific expectations about
other words, decision making should be based on continual updates
of personalised weighting of each treatment modality to achieve
the optimal oncofunctional balance.
In the era of integrated
diagnosis, therapeutic strategies cannot rely solely on molecular
profiling, but should also focus on radiological growth rates,
seizure activity, cognitive status, and the patient’s own