Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System
In 2021, the 5th edition of the WHO Classification of Tumors of the Central Nervous System (WHO-CNS5) was published as the sixth volume of the international standard for brain and spinal cord tumor classification. The most remarkable practical change in the current classification involves grading gl...
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| Format: | Article |
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MDPI AG
2023-01-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/2/197 |
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| author | Oana Gabriela Trifănescu Raluca Alexandra Trifănescu Radu Mitrică Dan Mitrea Ana Ciornei Mihai Georgescu Ioana Butnariu Laurenția Nicoleta Galeș Luiza Șerbănescu Rodica Maricela Anghel Mihai-Andrei Păun |
| author_facet | Oana Gabriela Trifănescu Raluca Alexandra Trifănescu Radu Mitrică Dan Mitrea Ana Ciornei Mihai Georgescu Ioana Butnariu Laurenția Nicoleta Galeș Luiza Șerbănescu Rodica Maricela Anghel Mihai-Andrei Păun |
| author_sort | Oana Gabriela Trifănescu |
| collection | DOAJ |
| description | In 2021, the 5th edition of the WHO Classification of Tumors of the Central Nervous System (WHO-CNS5) was published as the sixth volume of the international standard for brain and spinal cord tumor classification. The most remarkable practical change in the current classification involves grading gliomas according to molecular characterization. IDH mutant (10%) and IDH wild-type tumors (90%) are two different entities that possess unique biological features and various clinical outcomes regarding treatment response and overall survival. This article presents two comparative cases that highlight the clinical importance of these new classification standards. The first clinical case aimed to provide a comprehensive argument for determining the IDH status in tumors initially appearing as low-grade astrocytoma upon histologic examination, thus underlining the importance of the WHO-CNS5. The second case showed the implications of the histologic overdiagnosis of glioblastoma using the previous classification system with a treatment span of 7 years that proceeded through full-dose re-irradiation up to metronomic therapy. The new WHO-CNS5 classification significantly impacted complex neurooncological cases, thus changing the initial approach to a more precise therapeutic management. |
| first_indexed | 2024-03-09T13:04:17Z |
| format | Article |
| id | doaj.art-f4b079ca3714498f9cc33c238009f1fd |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T13:04:17Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-f4b079ca3714498f9cc33c238009f1fd2023-11-30T21:51:18ZengMDPI AGDiagnostics2075-44182023-01-0113219710.3390/diagnostics13020197Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous SystemOana Gabriela Trifănescu0Raluca Alexandra Trifănescu1Radu Mitrică2Dan Mitrea3Ana Ciornei4Mihai Georgescu5Ioana Butnariu6Laurenția Nicoleta Galeș7Luiza Șerbănescu8Rodica Maricela Anghel9Mihai-Andrei Păun10Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaRadiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, RomaniaRadiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, RomaniaDepartment of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Neurology, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, RomaniaDepartment of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaRadiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, RomaniaIn 2021, the 5th edition of the WHO Classification of Tumors of the Central Nervous System (WHO-CNS5) was published as the sixth volume of the international standard for brain and spinal cord tumor classification. The most remarkable practical change in the current classification involves grading gliomas according to molecular characterization. IDH mutant (10%) and IDH wild-type tumors (90%) are two different entities that possess unique biological features and various clinical outcomes regarding treatment response and overall survival. This article presents two comparative cases that highlight the clinical importance of these new classification standards. The first clinical case aimed to provide a comprehensive argument for determining the IDH status in tumors initially appearing as low-grade astrocytoma upon histologic examination, thus underlining the importance of the WHO-CNS5. The second case showed the implications of the histologic overdiagnosis of glioblastoma using the previous classification system with a treatment span of 7 years that proceeded through full-dose re-irradiation up to metronomic therapy. The new WHO-CNS5 classification significantly impacted complex neurooncological cases, thus changing the initial approach to a more precise therapeutic management.https://www.mdpi.com/2075-4418/13/2/197glioblastomaIDH statusWHO-CNS5gliomare-irradiation |
| spellingShingle | Oana Gabriela Trifănescu Raluca Alexandra Trifănescu Radu Mitrică Dan Mitrea Ana Ciornei Mihai Georgescu Ioana Butnariu Laurenția Nicoleta Galeș Luiza Șerbănescu Rodica Maricela Anghel Mihai-Andrei Păun Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System Diagnostics glioblastoma IDH status WHO-CNS5 glioma re-irradiation |
| title | Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System |
| title_full | Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System |
| title_fullStr | Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System |
| title_full_unstemmed | Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System |
| title_short | Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System |
| title_sort | upstaging and downstaging in gliomas clinical implications for the fifth edition of the world health organization classification of tumors of the central nervous system |
| topic | glioblastoma IDH status WHO-CNS5 glioma re-irradiation |
| url | https://www.mdpi.com/2075-4418/13/2/197 |
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