| . | Median Rating . | Lower IPR . | Delphi Round . |
|---|---|---|---|
| Appropriate diagnosis | |||
| 1. Tissue for diagnosis | |||
| S7. Histological diagnosis | 9 | 7 | 2 |
| 2. High-quality pathology reporting | |||
| D3a. Classification of brain tumor according to the latest version of WHO classification | 9 | 7 | 1 |
| D3b. Use of synoptic pathology reporting | 8 | 5 | 1 |
| 3. Optimal molecular testing | |||
| D4a. Molecular testing for glioblastomas | 9 | 8 | 1 |
| D4b. Molecular testing for astrocytomas | 9 | 8 | 1 |
| D5. Test for 1p/19q codeletions to diagnose oligodendrogliomas | 9 | 7 | 1 |
| D7. Test for MGMT promoter methylation in high-grade gliomas | 8 | 7 | 1 |
| D12. Test for BRAF mutation for diagnosis of pilocytic astrocytoma | 8 | 5 | 1 |
| D8. Diagnosis and treatment of ependymoma (RELA fusion) | 8 | 6 | 1 |
| 4. Medulloblastoma care | |||
| D13a. Medulloblastoma screening for CSF dissemination (MRI) | 9 | 8 | 1 |
| D13b. Medulloblastoma screening for CSF dissemination (CSF cytology) | 8 | 5 | 1 |
| Appropriate surgery | |||
| 5. Tumor specialist centers | |||
| S1. Surgery for brain tumors should be performed in tertiary centers | 9 | 8 | 1 |
| O32. Treatment of ependymoma | 9 | 5.6 | 1 |
| 6. Maximal safe resection (extent of surgery (biopsy/debulking/gross total resection) stratified by tumor type and grade (astrocytoma/oligodendroglioma/ependymoma/WHO II/III/IV) | |||
| S6a. Surgery to remove as much tumor as safely possible in low-grade glioma | 9 | 6 | 1 |
| S6b. Surgery to remove as much tumor as safely possible in high-grade glioma (glioblastoma and anaplastic astrocytoma) | 9 | 7 | 1 |
| S6c. Surgery to remove as much tumor as safely possible in high-grade ependymoma | 9 | 6.6 | 1 |
| Appropriate imaging | |||
| 7. MRI before and after surgery and on follow-up | |||
| D1. MRI for initial diagnosis | 9 | 8 | 1 |
| S8a. Baseline MRI post-surgery in high-grade glioma | 9 | 5 | 1 |
| S8b. Baseline MRI post-surgery in low-grade glioma | 7 | 5 | 2 |
| D9. Follow-up for assessment of progression or recurrence (clinical follow-up or imaging at least 6-week post-surgery) | 8 | 7 | 1 |
| Appropriate radiotherapy | |||
| 8. Radiotherapy dose tailored to age and pathology Radiotherapy dose stratified by tumor type (astrocytoma WHO II, oligodendroglioma WHO II and III, anaplastic astrocytoma, GBM, myxopapillary ependymoma) and age (younger and older than 70 years) | |||
| R1. Appropriate radiotherapy for patients with low-grade glioma | 8 | 7 | 1 |
| R2. Radiotherapy for patients with newly diagnosed 1p/19q co-deleted grade III glioma (anaplastic oligodendroglioma) | 9 | 7 | 1 |
| R3. Radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas without 1p19q co-deletion) | 9 | 7 | 1 |
| R4. Radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 7.6 | 1 |
| R5. Radiotherapy for patients over 70 with high-grade glioma | 8 | 4.4 | 1 |
| R6. Radiotherapy for incompletely resected myxopapillary ependymomas | 8 | 5.3 | 2 |
| 9. Timely radiotherapy | |||
| R7. Timely postoperative radiotherapy for high-grade glioma | 9 | 7 | 1 |
| Appropriate chemotherapy | |||
| 10. Initial chemotherapy Chemotherapy agent stratified by tumor type (low-grade glioma/anaplastic astrocytoma/anaplastic oligodendroglioma/GBM) and patient age. | |||
| C1a. Chemotherapy for patients with diffuse low-grade glioma | 8 | 5 | 1 |
| C1b. Chemotherapy for patients with anaplastic oligodendroglioma or astrocytoma (WHO grade III gliomas with and without 1p19q co-deletion) | 9 | 7 | 1 |
| C4. Temozolomide for patients with MGMT promoter methylated high-grade glioma | 9 | 7 | 1 |
| C8. Chemotherapy for pediatric brain tumor patients | 8 | 5.8 | 2 |
| 11. Concurrent chemoradiation for high-grade glioma | |||
| C2. Concurrent chemo and radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas, without 1p19q co-deletion) | 9 | 5.1 | 1 |
| C3a. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 8 | 1 |
| C3b. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged over 70 years | 8 | 5 | 2 |
| Other care | |||
| 12. MDT involvement | |||
| O1. Referral to a multidisciplinary team for decision making of management and treatment of brain tumor after diagnosis | 9 | 7 | 1 |
| 13. Monitoring of well-being and performance | |||
| O2. Monitor patient’s physical, psychological, and cognitive well-being | 9 | 7 | 1 |
| O28. Documentation of performance status pre-treatment | 9 | 6 | 1 |
| O29. Documentation of performance status post-treatment | 9 | 6 | 1 |
| O19. Patient’s quality of life documented as highest priority | 8 | 5.2 | 1 |
| O30a. Reduce hospital admissions and maximize patient time at home (hospital days between diagnosis and death) | 8 | 5 | 2 |
| 14. Psychosocial support | |||
| O4a. Health and social care support for patients and their caregivers (referral to social care support) | 9 | 7 | 1 |
| O4b. Health and social care support for patients and their caregivers (institution with care coordinator) | 9 | 7 | 1 |
| 15. Appropriate specialist and supportive referrals | |||
| O3. Referral to rehabilitation | 9 | 5 | 1 |
| O23. Palliative and supportive care | 9 | 6 | 1 |
| O21. Referral to other rehabilitation services such as occupational and speech therapy | 8 | 5 | 1 |
| O5b. Patient’s needs for management of mood and behavioral disorders (referral to a psychiatrist, psychologist, or other counselor) | 8 | 4.7 | 2 |
| O31. Ophthalmological assessment | 9 | 5.8 | 2 |
| 16. Seizure management | |||
| O8. Appropriate management of seizures | 9 | 5 | 1 |
| 17. Open communication | |||
| O6. Open communication with patients and their caregivers | 9 | 7 | 1 |
| 18. Treatment on recurrence Surgery, chemotherapy, and radiation on recurrence stratified by treatment type, tumor type, and age | |||
| New Item. Referral to a MDT for decision making of management and treatment of brain tumor after recurrence. | — | — | — |
| S11. Biopsy or resect low-grade glioma on recurrence or progression | 7 | 5 | 1 |
| S12. Biopsy or resect high-grade glioma on recurrence or progression | 7 | 5 | 2 |
| C5. Chemotherapy for recurrent glioblastoma | 7 | 5 | 2 |
| C6a. Chemotherapy for recurrent high-grade glioma | 7 | 4.1 | 2 |
| C6b. Chemotherapy for recurrent low-grade glioma | 7 | 5 | 2 |
| 19. Involvement in research | |||
| O24. Clinical trial | 8 | 5 | 1 |
| O25. Biobanking | 8 | 5 | 1 |
| O26. Biospecimens for research | 8 | 5 | 1 |
| . | Median Rating . | Lower IPR . | Delphi Round . |
|---|---|---|---|
| Appropriate diagnosis | |||
| 1. Tissue for diagnosis | |||
| S7. Histological diagnosis | 9 | 7 | 2 |
| 2. High-quality pathology reporting | |||
| D3a. Classification of brain tumor according to the latest version of WHO classification | 9 | 7 | 1 |
| D3b. Use of synoptic pathology reporting | 8 | 5 | 1 |
| 3. Optimal molecular testing | |||
| D4a. Molecular testing for glioblastomas | 9 | 8 | 1 |
| D4b. Molecular testing for astrocytomas | 9 | 8 | 1 |
| D5. Test for 1p/19q codeletions to diagnose oligodendrogliomas | 9 | 7 | 1 |
| D7. Test for MGMT promoter methylation in high-grade gliomas | 8 | 7 | 1 |
| D12. Test for BRAF mutation for diagnosis of pilocytic astrocytoma | 8 | 5 | 1 |
| D8. Diagnosis and treatment of ependymoma (RELA fusion) | 8 | 6 | 1 |
| 4. Medulloblastoma care | |||
| D13a. Medulloblastoma screening for CSF dissemination (MRI) | 9 | 8 | 1 |
| D13b. Medulloblastoma screening for CSF dissemination (CSF cytology) | 8 | 5 | 1 |
| Appropriate surgery | |||
| 5. Tumor specialist centers | |||
| S1. Surgery for brain tumors should be performed in tertiary centers | 9 | 8 | 1 |
| O32. Treatment of ependymoma | 9 | 5.6 | 1 |
| 6. Maximal safe resection (extent of surgery (biopsy/debulking/gross total resection) stratified by tumor type and grade (astrocytoma/oligodendroglioma/ependymoma/WHO II/III/IV) | |||
| S6a. Surgery to remove as much tumor as safely possible in low-grade glioma | 9 | 6 | 1 |
| S6b. Surgery to remove as much tumor as safely possible in high-grade glioma (glioblastoma and anaplastic astrocytoma) | 9 | 7 | 1 |
| S6c. Surgery to remove as much tumor as safely possible in high-grade ependymoma | 9 | 6.6 | 1 |
| Appropriate imaging | |||
| 7. MRI before and after surgery and on follow-up | |||
| D1. MRI for initial diagnosis | 9 | 8 | 1 |
| S8a. Baseline MRI post-surgery in high-grade glioma | 9 | 5 | 1 |
| S8b. Baseline MRI post-surgery in low-grade glioma | 7 | 5 | 2 |
| D9. Follow-up for assessment of progression or recurrence (clinical follow-up or imaging at least 6-week post-surgery) | 8 | 7 | 1 |
| Appropriate radiotherapy | |||
| 8. Radiotherapy dose tailored to age and pathology Radiotherapy dose stratified by tumor type (astrocytoma WHO II, oligodendroglioma WHO II and III, anaplastic astrocytoma, GBM, myxopapillary ependymoma) and age (younger and older than 70 years) | |||
| R1. Appropriate radiotherapy for patients with low-grade glioma | 8 | 7 | 1 |
| R2. Radiotherapy for patients with newly diagnosed 1p/19q co-deleted grade III glioma (anaplastic oligodendroglioma) | 9 | 7 | 1 |
| R3. Radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas without 1p19q co-deletion) | 9 | 7 | 1 |
| R4. Radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 7.6 | 1 |
| R5. Radiotherapy for patients over 70 with high-grade glioma | 8 | 4.4 | 1 |
| R6. Radiotherapy for incompletely resected myxopapillary ependymomas | 8 | 5.3 | 2 |
| 9. Timely radiotherapy | |||
| R7. Timely postoperative radiotherapy for high-grade glioma | 9 | 7 | 1 |
| Appropriate chemotherapy | |||
| 10. Initial chemotherapy Chemotherapy agent stratified by tumor type (low-grade glioma/anaplastic astrocytoma/anaplastic oligodendroglioma/GBM) and patient age. | |||
| C1a. Chemotherapy for patients with diffuse low-grade glioma | 8 | 5 | 1 |
| C1b. Chemotherapy for patients with anaplastic oligodendroglioma or astrocytoma (WHO grade III gliomas with and without 1p19q co-deletion) | 9 | 7 | 1 |
| C4. Temozolomide for patients with MGMT promoter methylated high-grade glioma | 9 | 7 | 1 |
| C8. Chemotherapy for pediatric brain tumor patients | 8 | 5.8 | 2 |
| 11. Concurrent chemoradiation for high-grade glioma | |||
| C2. Concurrent chemo and radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas, without 1p19q co-deletion) | 9 | 5.1 | 1 |
| C3a. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 8 | 1 |
| C3b. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged over 70 years | 8 | 5 | 2 |
| Other care | |||
| 12. MDT involvement | |||
| O1. Referral to a multidisciplinary team for decision making of management and treatment of brain tumor after diagnosis | 9 | 7 | 1 |
| 13. Monitoring of well-being and performance | |||
| O2. Monitor patient’s physical, psychological, and cognitive well-being | 9 | 7 | 1 |
| O28. Documentation of performance status pre-treatment | 9 | 6 | 1 |
| O29. Documentation of performance status post-treatment | 9 | 6 | 1 |
| O19. Patient’s quality of life documented as highest priority | 8 | 5.2 | 1 |
| O30a. Reduce hospital admissions and maximize patient time at home (hospital days between diagnosis and death) | 8 | 5 | 2 |
| 14. Psychosocial support | |||
| O4a. Health and social care support for patients and their caregivers (referral to social care support) | 9 | 7 | 1 |
| O4b. Health and social care support for patients and their caregivers (institution with care coordinator) | 9 | 7 | 1 |
| 15. Appropriate specialist and supportive referrals | |||
| O3. Referral to rehabilitation | 9 | 5 | 1 |
| O23. Palliative and supportive care | 9 | 6 | 1 |
| O21. Referral to other rehabilitation services such as occupational and speech therapy | 8 | 5 | 1 |
| O5b. Patient’s needs for management of mood and behavioral disorders (referral to a psychiatrist, psychologist, or other counselor) | 8 | 4.7 | 2 |
| O31. Ophthalmological assessment | 9 | 5.8 | 2 |
| 16. Seizure management | |||
| O8. Appropriate management of seizures | 9 | 5 | 1 |
| 17. Open communication | |||
| O6. Open communication with patients and their caregivers | 9 | 7 | 1 |
| 18. Treatment on recurrence Surgery, chemotherapy, and radiation on recurrence stratified by treatment type, tumor type, and age | |||
| New Item. Referral to a MDT for decision making of management and treatment of brain tumor after recurrence. | — | — | — |
| S11. Biopsy or resect low-grade glioma on recurrence or progression | 7 | 5 | 1 |
| S12. Biopsy or resect high-grade glioma on recurrence or progression | 7 | 5 | 2 |
| C5. Chemotherapy for recurrent glioblastoma | 7 | 5 | 2 |
| C6a. Chemotherapy for recurrent high-grade glioma | 7 | 4.1 | 2 |
| C6b. Chemotherapy for recurrent low-grade glioma | 7 | 5 | 2 |
| 19. Involvement in research | |||
| O24. Clinical trial | 8 | 5 | 1 |
| O25. Biobanking | 8 | 5 | 1 |
| O26. Biospecimens for research | 8 | 5 | 1 |
Abbreviations: CQI, clinical quality indicator; CSF cerebrospinal fluid; GBM glioblastoma; IPR inter-percentile range; MDT multidisciplinary team; MGMT O6-methylguanine-DNA methyltransferase; MRI magnetic resonance imaging.
| . | Median Rating . | Lower IPR . | Delphi Round . |
|---|---|---|---|
| Appropriate diagnosis | |||
| 1. Tissue for diagnosis | |||
| S7. Histological diagnosis | 9 | 7 | 2 |
| 2. High-quality pathology reporting | |||
| D3a. Classification of brain tumor according to the latest version of WHO classification | 9 | 7 | 1 |
| D3b. Use of synoptic pathology reporting | 8 | 5 | 1 |
| 3. Optimal molecular testing | |||
| D4a. Molecular testing for glioblastomas | 9 | 8 | 1 |
| D4b. Molecular testing for astrocytomas | 9 | 8 | 1 |
| D5. Test for 1p/19q codeletions to diagnose oligodendrogliomas | 9 | 7 | 1 |
| D7. Test for MGMT promoter methylation in high-grade gliomas | 8 | 7 | 1 |
| D12. Test for BRAF mutation for diagnosis of pilocytic astrocytoma | 8 | 5 | 1 |
| D8. Diagnosis and treatment of ependymoma (RELA fusion) | 8 | 6 | 1 |
| 4. Medulloblastoma care | |||
| D13a. Medulloblastoma screening for CSF dissemination (MRI) | 9 | 8 | 1 |
| D13b. Medulloblastoma screening for CSF dissemination (CSF cytology) | 8 | 5 | 1 |
| Appropriate surgery | |||
| 5. Tumor specialist centers | |||
| S1. Surgery for brain tumors should be performed in tertiary centers | 9 | 8 | 1 |
| O32. Treatment of ependymoma | 9 | 5.6 | 1 |
| 6. Maximal safe resection (extent of surgery (biopsy/debulking/gross total resection) stratified by tumor type and grade (astrocytoma/oligodendroglioma/ependymoma/WHO II/III/IV) | |||
| S6a. Surgery to remove as much tumor as safely possible in low-grade glioma | 9 | 6 | 1 |
| S6b. Surgery to remove as much tumor as safely possible in high-grade glioma (glioblastoma and anaplastic astrocytoma) | 9 | 7 | 1 |
| S6c. Surgery to remove as much tumor as safely possible in high-grade ependymoma | 9 | 6.6 | 1 |
| Appropriate imaging | |||
| 7. MRI before and after surgery and on follow-up | |||
| D1. MRI for initial diagnosis | 9 | 8 | 1 |
| S8a. Baseline MRI post-surgery in high-grade glioma | 9 | 5 | 1 |
| S8b. Baseline MRI post-surgery in low-grade glioma | 7 | 5 | 2 |
| D9. Follow-up for assessment of progression or recurrence (clinical follow-up or imaging at least 6-week post-surgery) | 8 | 7 | 1 |
| Appropriate radiotherapy | |||
| 8. Radiotherapy dose tailored to age and pathology Radiotherapy dose stratified by tumor type (astrocytoma WHO II, oligodendroglioma WHO II and III, anaplastic astrocytoma, GBM, myxopapillary ependymoma) and age (younger and older than 70 years) | |||
| R1. Appropriate radiotherapy for patients with low-grade glioma | 8 | 7 | 1 |
| R2. Radiotherapy for patients with newly diagnosed 1p/19q co-deleted grade III glioma (anaplastic oligodendroglioma) | 9 | 7 | 1 |
| R3. Radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas without 1p19q co-deletion) | 9 | 7 | 1 |
| R4. Radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 7.6 | 1 |
| R5. Radiotherapy for patients over 70 with high-grade glioma | 8 | 4.4 | 1 |
| R6. Radiotherapy for incompletely resected myxopapillary ependymomas | 8 | 5.3 | 2 |
| 9. Timely radiotherapy | |||
| R7. Timely postoperative radiotherapy for high-grade glioma | 9 | 7 | 1 |
| Appropriate chemotherapy | |||
| 10. Initial chemotherapy Chemotherapy agent stratified by tumor type (low-grade glioma/anaplastic astrocytoma/anaplastic oligodendroglioma/GBM) and patient age. | |||
| C1a. Chemotherapy for patients with diffuse low-grade glioma | 8 | 5 | 1 |
| C1b. Chemotherapy for patients with anaplastic oligodendroglioma or astrocytoma (WHO grade III gliomas with and without 1p19q co-deletion) | 9 | 7 | 1 |
| C4. Temozolomide for patients with MGMT promoter methylated high-grade glioma | 9 | 7 | 1 |
| C8. Chemotherapy for pediatric brain tumor patients | 8 | 5.8 | 2 |
| 11. Concurrent chemoradiation for high-grade glioma | |||
| C2. Concurrent chemo and radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas, without 1p19q co-deletion) | 9 | 5.1 | 1 |
| C3a. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 8 | 1 |
| C3b. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged over 70 years | 8 | 5 | 2 |
| Other care | |||
| 12. MDT involvement | |||
| O1. Referral to a multidisciplinary team for decision making of management and treatment of brain tumor after diagnosis | 9 | 7 | 1 |
| 13. Monitoring of well-being and performance | |||
| O2. Monitor patient’s physical, psychological, and cognitive well-being | 9 | 7 | 1 |
| O28. Documentation of performance status pre-treatment | 9 | 6 | 1 |
| O29. Documentation of performance status post-treatment | 9 | 6 | 1 |
| O19. Patient’s quality of life documented as highest priority | 8 | 5.2 | 1 |
| O30a. Reduce hospital admissions and maximize patient time at home (hospital days between diagnosis and death) | 8 | 5 | 2 |
| 14. Psychosocial support | |||
| O4a. Health and social care support for patients and their caregivers (referral to social care support) | 9 | 7 | 1 |
| O4b. Health and social care support for patients and their caregivers (institution with care coordinator) | 9 | 7 | 1 |
| 15. Appropriate specialist and supportive referrals | |||
| O3. Referral to rehabilitation | 9 | 5 | 1 |
| O23. Palliative and supportive care | 9 | 6 | 1 |
| O21. Referral to other rehabilitation services such as occupational and speech therapy | 8 | 5 | 1 |
| O5b. Patient’s needs for management of mood and behavioral disorders (referral to a psychiatrist, psychologist, or other counselor) | 8 | 4.7 | 2 |
| O31. Ophthalmological assessment | 9 | 5.8 | 2 |
| 16. Seizure management | |||
| O8. Appropriate management of seizures | 9 | 5 | 1 |
| 17. Open communication | |||
| O6. Open communication with patients and their caregivers | 9 | 7 | 1 |
| 18. Treatment on recurrence Surgery, chemotherapy, and radiation on recurrence stratified by treatment type, tumor type, and age | |||
| New Item. Referral to a MDT for decision making of management and treatment of brain tumor after recurrence. | — | — | — |
| S11. Biopsy or resect low-grade glioma on recurrence or progression | 7 | 5 | 1 |
| S12. Biopsy or resect high-grade glioma on recurrence or progression | 7 | 5 | 2 |
| C5. Chemotherapy for recurrent glioblastoma | 7 | 5 | 2 |
| C6a. Chemotherapy for recurrent high-grade glioma | 7 | 4.1 | 2 |
| C6b. Chemotherapy for recurrent low-grade glioma | 7 | 5 | 2 |
| 19. Involvement in research | |||
| O24. Clinical trial | 8 | 5 | 1 |
| O25. Biobanking | 8 | 5 | 1 |
| O26. Biospecimens for research | 8 | 5 | 1 |
| . | Median Rating . | Lower IPR . | Delphi Round . |
|---|---|---|---|
| Appropriate diagnosis | |||
| 1. Tissue for diagnosis | |||
| S7. Histological diagnosis | 9 | 7 | 2 |
| 2. High-quality pathology reporting | |||
| D3a. Classification of brain tumor according to the latest version of WHO classification | 9 | 7 | 1 |
| D3b. Use of synoptic pathology reporting | 8 | 5 | 1 |
| 3. Optimal molecular testing | |||
| D4a. Molecular testing for glioblastomas | 9 | 8 | 1 |
| D4b. Molecular testing for astrocytomas | 9 | 8 | 1 |
| D5. Test for 1p/19q codeletions to diagnose oligodendrogliomas | 9 | 7 | 1 |
| D7. Test for MGMT promoter methylation in high-grade gliomas | 8 | 7 | 1 |
| D12. Test for BRAF mutation for diagnosis of pilocytic astrocytoma | 8 | 5 | 1 |
| D8. Diagnosis and treatment of ependymoma (RELA fusion) | 8 | 6 | 1 |
| 4. Medulloblastoma care | |||
| D13a. Medulloblastoma screening for CSF dissemination (MRI) | 9 | 8 | 1 |
| D13b. Medulloblastoma screening for CSF dissemination (CSF cytology) | 8 | 5 | 1 |
| Appropriate surgery | |||
| 5. Tumor specialist centers | |||
| S1. Surgery for brain tumors should be performed in tertiary centers | 9 | 8 | 1 |
| O32. Treatment of ependymoma | 9 | 5.6 | 1 |
| 6. Maximal safe resection (extent of surgery (biopsy/debulking/gross total resection) stratified by tumor type and grade (astrocytoma/oligodendroglioma/ependymoma/WHO II/III/IV) | |||
| S6a. Surgery to remove as much tumor as safely possible in low-grade glioma | 9 | 6 | 1 |
| S6b. Surgery to remove as much tumor as safely possible in high-grade glioma (glioblastoma and anaplastic astrocytoma) | 9 | 7 | 1 |
| S6c. Surgery to remove as much tumor as safely possible in high-grade ependymoma | 9 | 6.6 | 1 |
| Appropriate imaging | |||
| 7. MRI before and after surgery and on follow-up | |||
| D1. MRI for initial diagnosis | 9 | 8 | 1 |
| S8a. Baseline MRI post-surgery in high-grade glioma | 9 | 5 | 1 |
| S8b. Baseline MRI post-surgery in low-grade glioma | 7 | 5 | 2 |
| D9. Follow-up for assessment of progression or recurrence (clinical follow-up or imaging at least 6-week post-surgery) | 8 | 7 | 1 |
| Appropriate radiotherapy | |||
| 8. Radiotherapy dose tailored to age and pathology Radiotherapy dose stratified by tumor type (astrocytoma WHO II, oligodendroglioma WHO II and III, anaplastic astrocytoma, GBM, myxopapillary ependymoma) and age (younger and older than 70 years) | |||
| R1. Appropriate radiotherapy for patients with low-grade glioma | 8 | 7 | 1 |
| R2. Radiotherapy for patients with newly diagnosed 1p/19q co-deleted grade III glioma (anaplastic oligodendroglioma) | 9 | 7 | 1 |
| R3. Radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas without 1p19q co-deletion) | 9 | 7 | 1 |
| R4. Radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 7.6 | 1 |
| R5. Radiotherapy for patients over 70 with high-grade glioma | 8 | 4.4 | 1 |
| R6. Radiotherapy for incompletely resected myxopapillary ependymomas | 8 | 5.3 | 2 |
| 9. Timely radiotherapy | |||
| R7. Timely postoperative radiotherapy for high-grade glioma | 9 | 7 | 1 |
| Appropriate chemotherapy | |||
| 10. Initial chemotherapy Chemotherapy agent stratified by tumor type (low-grade glioma/anaplastic astrocytoma/anaplastic oligodendroglioma/GBM) and patient age. | |||
| C1a. Chemotherapy for patients with diffuse low-grade glioma | 8 | 5 | 1 |
| C1b. Chemotherapy for patients with anaplastic oligodendroglioma or astrocytoma (WHO grade III gliomas with and without 1p19q co-deletion) | 9 | 7 | 1 |
| C4. Temozolomide for patients with MGMT promoter methylated high-grade glioma | 9 | 7 | 1 |
| C8. Chemotherapy for pediatric brain tumor patients | 8 | 5.8 | 2 |
| 11. Concurrent chemoradiation for high-grade glioma | |||
| C2. Concurrent chemo and radiotherapy for patients with anaplastic astrocytoma (WHO grade III gliomas, without 1p19q co-deletion) | 9 | 5.1 | 1 |
| C3a. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged under 70 years | 9 | 8 | 1 |
| C3b. Temozolomide as concurrent and adjuvant treatment following radiotherapy for patients with newly diagnosed glioblastoma aged over 70 years | 8 | 5 | 2 |
| Other care | |||
| 12. MDT involvement | |||
| O1. Referral to a multidisciplinary team for decision making of management and treatment of brain tumor after diagnosis | 9 | 7 | 1 |
| 13. Monitoring of well-being and performance | |||
| O2. Monitor patient’s physical, psychological, and cognitive well-being | 9 | 7 | 1 |
| O28. Documentation of performance status pre-treatment | 9 | 6 | 1 |
| O29. Documentation of performance status post-treatment | 9 | 6 | 1 |
| O19. Patient’s quality of life documented as highest priority | 8 | 5.2 | 1 |
| O30a. Reduce hospital admissions and maximize patient time at home (hospital days between diagnosis and death) | 8 | 5 | 2 |
| 14. Psychosocial support | |||
| O4a. Health and social care support for patients and their caregivers (referral to social care support) | 9 | 7 | 1 |
| O4b. Health and social care support for patients and their caregivers (institution with care coordinator) | 9 | 7 | 1 |
| 15. Appropriate specialist and supportive referrals | |||
| O3. Referral to rehabilitation | 9 | 5 | 1 |
| O23. Palliative and supportive care | 9 | 6 | 1 |
| O21. Referral to other rehabilitation services such as occupational and speech therapy | 8 | 5 | 1 |
| O5b. Patient’s needs for management of mood and behavioral disorders (referral to a psychiatrist, psychologist, or other counselor) | 8 | 4.7 | 2 |
| O31. Ophthalmological assessment | 9 | 5.8 | 2 |
| 16. Seizure management | |||
| O8. Appropriate management of seizures | 9 | 5 | 1 |
| 17. Open communication | |||
| O6. Open communication with patients and their caregivers | 9 | 7 | 1 |
| 18. Treatment on recurrence Surgery, chemotherapy, and radiation on recurrence stratified by treatment type, tumor type, and age | |||
| New Item. Referral to a MDT for decision making of management and treatment of brain tumor after recurrence. | — | — | — |
| S11. Biopsy or resect low-grade glioma on recurrence or progression | 7 | 5 | 1 |
| S12. Biopsy or resect high-grade glioma on recurrence or progression | 7 | 5 | 2 |
| C5. Chemotherapy for recurrent glioblastoma | 7 | 5 | 2 |
| C6a. Chemotherapy for recurrent high-grade glioma | 7 | 4.1 | 2 |
| C6b. Chemotherapy for recurrent low-grade glioma | 7 | 5 | 2 |
| 19. Involvement in research | |||
| O24. Clinical trial | 8 | 5 | 1 |
| O25. Biobanking | 8 | 5 | 1 |
| O26. Biospecimens for research | 8 | 5 | 1 |
Abbreviations: CQI, clinical quality indicator; CSF cerebrospinal fluid; GBM glioblastoma; IPR inter-percentile range; MDT multidisciplinary team; MGMT O6-methylguanine-DNA methyltransferase; MRI magnetic resonance imaging.
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