The objective is to define guidelines for the management of adult patients with glioma. The management of spinal, non-glial, hypophyseal, neuronal tumours and schwannomas and the management of childhood glioma are not covered in this document. The general methodology used has already been described ( Fervers et al, 2001 ). For this specific SOR, a multidisciplinary working group was set up by the French National Federation of Cancer Centres (Fédération Nationale des Centres de Lutte Contre le Cancer–FNCLCC) and the Association of French-speaking Neuro-oncologists (Association des Neuro-Oncologues d'Expression Française–ANOCEF) to review the best available evidence on the management of adult patients with glioma. Medline and Cancerlit were searched using a specific strategy, for the period 1990–2000. In addition, the members of the working group provided references from their personal sources up to 2001. The majority of the articles thus identified were in English or French. Many of the articles identified reported results for heterogeneous populations of patients (adults and children, and types of glioma), and therefore, when possible, information had to be extracted for specific populations and tumours. However, as this was not possible in all publications, not all the available literature could be analysed. Following the selection and critical appraisal of the articles, the working group produced a document with the proposed ‘Standards’, ‘Options’ and ‘Recommendations’ (SORs) for the management of adult patients with glioma, based on scientific evidence or expert agreement. The document was then peer-reviewed by independent experts, and their comments were integrated in the final version. When all the members of the working group agree, based on the best available evidence, that a procedure or intervention is beneficial, inappropriate, or harmful, it is classified as a ‘ Standard ’, and when the majority agree, it is classified as an ‘ Option ’ ( Table 1 ). In the SORs, there can be several ‘ Options ’ for a given clinical situation. ‘ Recommendations ’ provide additional information that enable the available options to be ranked using explicit criteria (e.g. survival, toxicity) with an indication of the level of evidence. These recommendations thus help clinicians to select an appropriate option. Thus, clinicians can make choices for the management of patients using this information and taking into consideration local circumstances, skills, equipment, resources and/or patient preferences. The adaptation of the SOR to the local situation is allowable if the reason for the choice is sufficiently transparent and this is crucial for successful implementation. Inclusion of patients in clinical trials is an appropriate form of patient management in oncology and is recommended frequently within the SORs, particularly in situations where only weak evidence exists to support a procedure or an intervention. The type of evidence underlying any ‘Standard’, ‘Option’ or ‘ Recommendation ’ is indicated using a classification developed by the FNCLCC based on previously published methods. The level of evidence depends not only on the type and quality of the studies reviewed, but also on the concordance of the results ( Table 2 ). When no clear scientific evidence exists, judgement is made according to the professional experience and consensus of the expert group (‘expert agreement’ ), and this is validated by the peer-review process. This summary version has been translated from the French summary version, which was based on the integral version that will be published on the internet ( http://www.fnclcc.fr ).
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Frappaz et al. (2003) studied this question.