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Abstract
BACKGROUND:
There was no practical guideline for the management of patients with central nervous system tumor in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has developed the guideline for glioblastoma. Subsequently, the KSNO guideline for World Health Organization (WHO) grade II cerebral glioma in adults is established.

METHODS:
The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords regarding diffuse astrocytoma and oligodendroglioma of brain in adults.

RESULTS:
Whenever radiological feature suggests lower grade glioma, the maximal safe resection if feasible is recommended globally. After molecular and histological examinations, patients with diffuse astrocytoma, isocitrate dehydrogenase (IDH)-wildtype without molecular feature of glioblastoma should be primarily treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy (Level III) while those with molecular feature of glioblastoma should be treated following the protocol for glioblastomas. In terms of patients with diffuse astrocytoma, IDH-mutant and oligodendroglioma (IDH-mutant and 1p19q codeletion), standard brain radiotherapy and adjuvant PCV (procarbazine+lomustine+vincristine) combination chemotherapy should be considered primarily for the high-risk group while observation with regular follow up should be considered for the low-risk group.

CONCLUSION:
The KSNO's guideline recommends that WHO grade II gliomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors and clinical characteristics of patients.

Author information

Kim YZ1, Kim CY2, Wee CW3, Roh TH4, Hong JB5, Oh HJ6, Kang SG7, Kang SH8, Kong DS9, Kim SH10, Kim SH4, Kim SH11, Kim YJ12, Kim EH7, Kim IA3, Kim HS13, Park JS14, Park HJ15, Song SW16, Sung KS17, Yang SH18, Yoon WS19, Yoon HI20, Lee J21, Lee ST22, Lee SW23, Lee YS24, Lim J25, Chang JH7, Jung TY26, Jung HL27, Cho JH20, Choi SH28, Choi HS29, Lim DH#30, Chung DS#31; KSNO Guideline Working Group.
1
Division of Neurooncology and Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
2
Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
3
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
4
Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
5
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
6
Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
7
Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
8
Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
9
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
10
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
11
Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
12
Division of Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
13
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
14
Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
15
Clinic of Pediatric Oncology, National Cancer Center, Goyang, Korea.
16
Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
17
Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea.
18
Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
19
Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
20
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
21
Department of Radiation Oncology, Ewha Women's University Mokdong Hospital, Ewha Women's University School of Medicine, Seoul, Korea.
22
Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
23
Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
24
Department of Pathology, Seoul St. Marry's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
25
Department of Neurosurgery, Bundang CHA Medical Center, CHA University, Seongnam, Korea.
26
Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.
27
Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
28
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
29
Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
30
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dh8lim@skku.edu.
31
Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. dschung@catholic.ac.kr.
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Contributed equally