Upstaging and Downstaging in Gliomas—Clinical Implications for the Fifth Edition of the World Health Organization Classification of Tumors of the Central Nervous System
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
Affiliations
Oana Gabriela Trifănescu
Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Raluca Alexandra Trifănescu
Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Radu Mitrică
Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Dan Mitrea
Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
Ana Ciornei
Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
Mihai Georgescu
Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Ioana Butnariu
Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania
Laurenția Nicoleta Galeș
Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Luiza Șerbănescu
Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Rodica Maricela Anghel
Department of Oncology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
Mihai-Andrei Păun
Radiotherapy II, “Prof. Dr. Al. Trestioreanu” Institute of Oncology, 022328 Bucharest, Romania
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.
