PURPOSE: The European Society of Medical Oncology (ESMO) magnitude of clinical benefit scale (MCBS) version 1.1 is an evaluation scale that was developed to evaluate the MCBS reported in clinical research studies of canc...PURPOSE: The European Society of Medical Oncology (ESMO) magnitude of clinical benefit scale (MCBS) version 1.1 is an evaluation scale that was developed to evaluate the MCBS reported in clinical research studies of cancer treatments. The American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) created joint guidelines for the use of local therapy in the management of extracranial oligometastatic non-small cell lung cancer (NSCLC). We applied the ESMO-MCBS v.1.1 to evaluate the clinical benefit reported in studies that informed the ASTRO/ESTRO guidelines. METHODS AND MATERIALS: We applied the ESMO-MCBS v1.1 to the 23 studies identified by the ASTRO/ESTRO taskforce. As well, we evaluated the recently published Consolidative Use of Radiotherapy to Block Oligoprogression study and Stereotactic Radiotherapy for Oligo-Progressive Metastatic Cancer Trial, for a total of 25 studies evaluated. All evaluated studies were graded by at least 3 of the authors. Any discrepancies were subsequently reviewed by the scoring authors. RESULTS: The addition of stereotactic body radiation therapy to all sites of oligometastatic disease in combination with standard-of-care chemotherapy was associated with substantial improvements in survival. These studies resulted in a score of 4 using form 2a (noncurative treatment with overall survival from standard therapy between 12 and 24 months). Of the 10 prospective single-arm studies, 9 received a score of 3 using form 3, due to progression-free survival exceeding 6 months. No studies received a score of 5 (highest clinical benefit). CONCLUSIONS: The use of local radiation in the treatment of extracranial oligometastatic NSCLC is associated with a substantial clinical benefit, according to the ESMO-MCBS v1.1. Radiation therapy was comparable to established and groundbreaking targeted therapies such as pembrolizumab in combination with pemetrexed for epidermal growth factor receptor and anaplastic lymphoma kinase-negative NSCLC, and osimertinib for epidermal growth factor receptor-mutated NSCLC. MCBS would be even higher if quality-of-life improvements are found in future trials.
Yuan L, Chen Q, Al-Hallaq H
… +11 more, Yang J, Yang X, Geng H, Latifi K, Cai B, Wu QJ, Xiao Y, Benedict SH, Rong Y, Buchsbaum J, Qi XS
Pract Radiat Oncol
· 2026 · PMID 40854402
·
Full text
PURPOSE: This study aims to evaluate organs-at-risk (OARs) segmentation variability across 8 commercial artificial intelligence (AI)-based segmentation software using independent multi-institutional data sets, and to pro...PURPOSE: This study aims to evaluate organs-at-risk (OARs) segmentation variability across 8 commercial artificial intelligence (AI)-based segmentation software using independent multi-institutional data sets, and to provide recommendations for clinical practices using AI-segmentation. METHODS AND MATERIALS: A total of 160 planning computed tomography image sets from 4 anatomic sites: head and neck, thorax, abdomen, and pelvis were retrospectively pooled from 3 institutions. Contours for 31 OARs generated by the software were compared to clinical contours using multiple accuracy metrics, including: dice similarity coefficient (DSC), 95 percentile of Hausdorff distance, surface DSC, as well as relative added path length as an efficiency metric. A 2-factor analysis of variance was used to quantify variability in contouring accuracy across software platforms (intersoftware) and patients (interpatient). Pairwise comparisons were performed to categorize the software into different performance groups, and intersoftware variations were calculated as the average performance differences between the groups. RESULTS: Significant intersoftware and interpatient contouring accuracy variations (P < .05) were observed for most OARs. The largest intersoftware variations in DSC in each anatomic region were cervical esophagus (0.41), trachea (0.10), spinal cord (0.13), and prostate (0.17). Among the organs evaluated, 7 had mean DSC >0.9 (ie, heart, liver), 15 had DSC ranging from 0.7 to 0.89 (ie, parotid, esophagus). The remaining organs (ie, optic nerves, seminal vesicle) had DSC<0.7. Of the 31 organs, 16 (52%) had relative added path length less than 0.1. CONCLUSIONS: Our results reveal significant intersoftware and interpatient variability in the performance of AI-segmentation software. These findings highlight the need of thorough software commissioning, testing, and quality assurance across disease sites, patient-specific anatomies, and image acquisition protocols.
PURPOSE: Stereotactic body radiation therapy (SBRT) is a local treatment option for liver metastases. The introduction of magnetic resonance imaging (MRI) guided SBRT has paved the way for optimal treatment outcomes by i...PURPOSE: Stereotactic body radiation therapy (SBRT) is a local treatment option for liver metastases. The introduction of magnetic resonance imaging (MRI) guided SBRT has paved the way for optimal treatment outcomes by improving tumor visualization, daily plan adaptation and margin reduction. The purpose of this study was to review the tolerability of MRI-guided liver SBRT and to present early toxicity and quality of life (QoL) outcomes from a prospective multicenter registry. METHODS AND MATERIALS: All patients enrolled in the MOMENTUM study (NCT04075305) who were treated for liver metastases between April 2019 and April 2023 on a 1.5T MR-Linac were included. Descriptive statistics were used to present tolerability of treatment, acute toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0) and Quality of Life questionnaires (QLQ-C30 and EQ-5D-5L) at baseline and 3 months after treatment. RESULTS: A total of 135 patients (median age, 67 years; range, 31-93) were treated in 7 institutes across 4 countries. The most common primary tumor origins were colorectal (50%) and lung cancer (12%). Prescribed total SBRT doses ranged from 20.0 to 67.5 Gy, delivered in 2 to 12 fractions of 7 to 22.5 Gy per fraction (median biologically effective dose, 180 Gy; range, 59.5-540 Gy). A total of 97% of patients (n = 131) completed their treatment, with no interruptions due to poor tolerability. Up to 3 months, 14 grade 3 toxicities were reported in 12 patients (10.6%), with only 1 (0.9%) recorded as radiation therapy related (gastritis). No grade ≥4 toxicities were reported. Sixty-two and 63 patients completed the QLQ-C30 and EQ-5D-5L questionnaires at both time points, respectively. These showed a worsening of 5 to 10 points at 3 months for role functioning, nausea, fatigue, constipation, and pain. CONCLUSIONS: In this prospective cohort, 97% of treatments were well tolerated and completed successfully, with only 1 case of acute grade 3 radiation therapy related toxicity and no grade ≥4 toxicity reported. QoL outcomes showed clinically relevant worsening (defined as ≥5 points) in 5 domains, which is comparable to that of computed tomography (CT-) guided SBRT. Overall, the outcomes showed that MRI-guided SBRT is a well-tolerated and safe treatment for patients with liver metastases.
Proton treatment using pencil-beam scanning (PBS) for patients with breast cancer offers advantages in achieving a conformal dose distribution while also reducing the cardiac dose. However, when employing 2 anterior fiel...Proton treatment using pencil-beam scanning (PBS) for patients with breast cancer offers advantages in achieving a conformal dose distribution while also reducing the cardiac dose. However, when employing 2 anterior fields to mitigate the effects of respiratory motion on dose delivery, managing the ipsilateral lung doses becomes critical due to the high linear-energy transfer (LET) at the distal end of the beams. Although the incidence of radiation pneumonitis (RP) after breast radiation therapy is relatively low, it is essential to address the cases that develop RP following proton treatment to minimize lung toxicity. We conducted a retrospective case study analyzing follow-up computed tomography images taken at 1 week, 1.5 months, and 4.5 months after the onset of the patient's pneumonitis symptoms to correlate them with proton doses. The patient's PBS treatment was prescribed at a dose of 50 Gy with an additional 10 Gy boost, using a relative biological effectiveness (RBE) of 1.1, delivered in 2 Gy daily fractions. Our histogram analysis revealed noticeable increases in Hounsfield units at a dose of 40 Gy (RBE = 1.1), underscoring a potential dose-volume parameter that could help minimize the occurrence of RP. Furthermore, the lung volume associated with the RP was encompassed with an iso-LET level greater than 5.0 keV/μm, with a proton dose exceeding 40 Gy (RBE = 1.1). In examining the LET-dependent RBE-weighted dose using the McNamara model in the original treatment plan, we found the volumes receiving more than 50 Gy (V) and 40 Gy (V) were 110 cc and 267 cc, respectively. By incorporating dose objectives of V and V to limit the ipsilateral lung volume into PBS plans, the volumes were successfully reduced to 0 cc and 3 cc, while maintaining target dose coverage and robustness. Optimizing a breast PBS plan (RBE = 1.1) using objectives that addressed both the V and V to minimize lung exposure was shown to be clinically feasible and should be considered as a strategy to reduce lung toxicity when treating breast cancer with PBS proton therapy.
Dhere VR, Schuster DM, Goyal S
… +10 more, Schreibmann E, Sebastian NT, Patel SA, Hanasoge S, Shelton JW, Patel PR, Hershatter BW, Abiodun-Ojo OA, Lawal IO, Jani AB
Pract Radiat Oncol
· 2026 · PMID 40738247
·
Full text
PURPOSE: We evaluated changes in radiation therapy target volume and acute toxicity using Ga-prostate specific membrane antigen (PSMA) versus F-fluciclovine positron emission tomography (PET)/computed tomography in postp...PURPOSE: We evaluated changes in radiation therapy target volume and acute toxicity using Ga-prostate specific membrane antigen (PSMA) versus F-fluciclovine positron emission tomography (PET)/computed tomography in postprostatectomy patients with biochemical recurrence. We hypothesized that both fluciclovine and PSMA-guided radiation therapy would (1) significantly change pre-PET radiation therapy volumes and (2) show similar toxicity. METHODS AND MATERIALS: We performed an institutional review board-approved, randomized trial comparing fluciclovine (Arm 1) and PSMA (Arm 2)-guided postprostatectomy radiation therapy in patients with detectable prostate-specific antigen after prostatectomy. Treatment volumes were rigidly defined based on PET, and simultaneous integrated boosts to PET uptake in the prostate bed (70.2-76.0 Gy) or pelvis (54.0-56.0 Gy) were allowed. Clinical target volumes (CTVs) included: prostate bed (CTV); pelvic lymph nodes (CTV); and volumetric constraints for bladder(-CTV) and rectum. Acute genitourinary and gastrointestinal (GI) toxicity (per Common Terminology Criteria for Adverse Events v5.0) was assessed <90 days from treatment. RESULTS: In total, 140 patients were enrolled with 70 randomized to each arm; 11 Arm 1 and 10 Arm 2 patients did not receive radiation on study and were excluded. Fluciclovine and PSMA incorporation increased both CTV and CTV (P < .01). More fluciclovine patients received prostate bed boosts (45 of 59 patients vs 26 of 60 patients; P < .01), but there was no difference in proportion receiving pelvic nodal boosts (10 of 15 patients vs 9of 16 patients, fluciclovine vs PSMA; P = .97). Dose constraints were met for most patients. Rates of grade 2 genitourinary (17.0% vs 6.7%, fluciclovine vs PSMA; P = .15) and GI (5.1% vs 1.7%, fluciclovine vs PSMA; P = .47) toxicity were low, with no grade 3+ events. Higher rectal and bladder dose metrics correlated with GI toxicity (P < .05), but use of simultaneous integrated boosts was not associated with acute toxicity. CONCLUSIONS: Although both PSMA and fluciclovine use modestly increased target volumes, significantly more fluciclovine patients received prostate bed boosts. Planning directives were met for most patients, and acute toxicity was mild in both Arms. Analysis of biochemical control, late toxicity, and patient-reported outcomes are forthcoming.
Use of rectal spacer gel has been associated with decreased risk of radiation therapy (RT)-related rectal toxicity in clinical trials and has been increasingly adopted. Optimal management of spacer-related toxicities, su...Use of rectal spacer gel has been associated with decreased risk of radiation therapy (RT)-related rectal toxicity in clinical trials and has been increasingly adopted. Optimal management of spacer-related toxicities, such as rectal wall and vascular infiltration, remains poorly defined. To address this gap, we present a case of extensive hydrogel intravasation of the periprostatic venous plexus with development of associated bland thrombus extending to the level of the common iliac vein. The patient was evaluated for placement of an inferior vena cava (IVC) filter and anticoagulation by a multidisciplinary team. After undergoing 6 months of anticoagulation without IVC filter placement, both the hydrogel and the associated thrombus resolved asymptomatically. We review the timeline of these events, their associated symptomatology, our rationale in management of this clinical scenario, and propose a treatment paradigm.
Ehret F, Ebner DK, Kutuk T
… +13 more, Shakeri A, Shrestha S, Skalina KA, Fekrmandi F, Lo SS, Gore JL, Kotecha R, Lee P, Slotman BJ, Fürweger C, Muacevic A, Siva S, Reddy K
PURPOSE: Adrenal metastases are frequently diagnosed in patients with common solid tumors. Surgical adrenalectomy has historically been used for their management. However, stereotactic body radiation therapy (SBRT) has e...PURPOSE: Adrenal metastases are frequently diagnosed in patients with common solid tumors. Surgical adrenalectomy has historically been used for their management. However, stereotactic body radiation therapy (SBRT) has emerged as a safe and effective alternative. Careful treatment planning is essential, considering multiple factors such as tumor size and location, motion management, dose and fractionation, and proximity to adjacent organs at risk. This case-based practice guide and review provides an overview of SBRT for the management of adrenal tumors, with a particular focus on adrenal metastases. METHODS AND MATERIALS: Three clinical scenarios were selected to illustrate the use of SBRT in managing adrenal tumors. These include a small right-sided metastasis treated with single-fraction, fiducial-based SBRT, a large left-sided metastasis treated with fractionated SBRT under magnetic resonance imaging guidance, and a case of bilateral metastases, which emphasizes the potential risk of adrenal insufficiency. We also address the limited evidence available regarding the management of primary adrenal gland tumors with SBRT. RESULTS: SBRT is an effective treatment modality for most adrenal tumors, demonstrating a favorable safety profile. Thoughtful treatment planning and an understanding of potential pitfalls, limitations, and risks are essential to ensure the appropriate use of SBRT. CONCLUSIONS: This case-based guide and review provides a comprehensive overview of SBRT for treating adrenal tumors, specifically metastases. We present and discuss clinical cases and relevant literature, highlighting key considerations specific to adrenal SBRT.
PURPOSE: Primary cutaneous T-cell lymphomas are a rare and heterogeneous group of non-Hodgkin lymphomas predominantly affecting the skin. Treatment strategies are guided by diagnosis and disease stages. In patients with...PURPOSE: Primary cutaneous T-cell lymphomas are a rare and heterogeneous group of non-Hodgkin lymphomas predominantly affecting the skin. Treatment strategies are guided by diagnosis and disease stages. In patients with classical mycosis fungoides (MF) or folliculotropic mycosis fungoides, low-dose multiple fraction radiation therapy (RT) is a common approach for localized lesions, but optimal dose regimens are still to be defined. This study aimed to compare the efficacy of single-fraction low-dose RT (1 × 6 Gy) vs the well-accepted 2-fraction regimen (2 × 4 Gy) in patients with localized MF. METHODS AND MATERIALS: A cohort of 54 patients with confirmed diagnoses of classical MF or folliculotropic MF received low-dose RT with either 1 × 6 Gy or 2 × 4 Gy between January 2017 and December 2022. Outcomes assessed included complete response (CR) rates, freedom from treatment failure, and toxicity. RESULTS: The CR rate for 311 treated fields was 86%. There was no significant difference observed in complete response rate between the 88 fields treated with 1 × 6 Gy (88% CR) and the 223 fields treated with 2 × 4 Gy (86% CR) (P = .87). The freedom from treatment failure at 3 years furthermore showed similar outcomes for both regimens (71% for 2 × 4 Gy and 79% for 1 × 6 Gy; P = .18). There were no significant treatment-related toxicities reported. CONCLUSIONS: In this study, a single-fraction low-dose RT regimen (1 × 6 Gy) was shown to be comparable to the two-fraction regimen (2 × 4 Gy) in achieving CR for localized disease in patients with MF, offering a more convenient and patient-friendly option without compromising efficacy or safety. These findings support the incorporation of 1 × 6 Gy into clinical guidelines for the palliative management of MF.
Recent advancements in cardiology have significantly improved survival and quality of life for patients with severe heart conditions, including those requiring implantable cardioverter defibrillators (ICDs) and left vent...Recent advancements in cardiology have significantly improved survival and quality of life for patients with severe heart conditions, including those requiring implantable cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs). Radiation therapy (RT) using either conventional or advanced techniques, such as stereotactic body RT, remains a cornerstone treatment for cancer. However, managing patients with both ICDs and LVADs during RT presents unique challenges caused by potential device malfunctions and interactions with radiation. In this report, we present a case of a patient with both a triple-chamber ICD and an electronically equipped LVAD undergoing RT. The study explores the dosimetric considerations, device interactions, and adapted simulations required to minimize risks. This work aimed to bridge the knowledge gap and provide recommendations for the safe and effective integration of RT delivery in patients with advanced cardiac devices.
Postradiation therapy erectile dysfunction can significantly impact the quality of life of patients with prostate cancer (PCa). Critical anatomic structures, such as the neurovascular bundles (NVBs), internal pudendal ar...Postradiation therapy erectile dysfunction can significantly impact the quality of life of patients with prostate cancer (PCa). Critical anatomic structures, such as the neurovascular bundles (NVBs), internal pudendal arteries (IPAs), penile bulb, and corporal tissues track near the prostate, making them susceptible to radiation-related damage. This study aimed to evaluate the anatomic patterns of these structures and their relationship with the prostate and to provide comprehensive illustrative examples on magnetic resonance imaging (MRI) scans. Consecutive patients with PCa who underwent MRI-linear accelerator-based stereotactic body radiation therapy from January 2024 until December 2024 were included. NVB patterns were classified into 3 categories: (1) "classical" with discrete NVB elements, (2) "adherent," dispersed and adherent to prostatic capsule, and (3) "absent." The smallest distance between the IPA and the prostate capsule and the membranous urethral length, serving as a surrogate for the distance between corporal tissue and prostatic apex, were also measured. These MRI scan findings were compared between prostate volumes >40 and <40 mL and between MRI scan findings and pathologic features of the dominant intraprostatic lesion. A total of 160 men (median age 70 years, interquartile range [IQR], 64-76) were included. The most common NVB pattern was "classic" (80.0%-85.0%), followed by the "adherent" NVB pattern (13.8%-18.1%). The median smallest distance between the IPA and prostate was 2.3 cm (IQR, 1.8-2.8 cm), with 3.1% to 3.8% <1.0 cm. The median membranous urethral length was 1.5 cm (IQR, 1.2-1.8 cm), with 2.5% of patients <1.0 cm. No significant association was found between these MRI scan features and prostate volume or other variables (P = .09-.99). In conclusion, most patients with PCa demonstrated favorable anatomy for potential dose sparing of critical structures. Comprehensive MRI scan illustrations are provided to help radiation oncologists recognize the location, trajectory, and relationship of these structures, facilitating their contouring and ultimately aiding in achieving meaningful dose reductions to these erectile function structures.
PURPOSE: This study evaluated the clinical feasibility of hybrid brachytherapy and the benefits of computed tomography (CT) guidance for optimizing applicator position and needle placement via Utrecht or Venezia applicat...PURPOSE: This study evaluated the clinical feasibility of hybrid brachytherapy and the benefits of computed tomography (CT) guidance for optimizing applicator position and needle placement via Utrecht or Venezia applicators in the curative treatment of vaginal cuff recurrence. METHODS AND MATERIALS: Sixteen previously operated patients with gynecological cancer treated with hybrid brachytherapy for vaginal cuff recurrence from 2018 to 2022 were included. The applicators were selected according to vaginal diameter and tumor location. CT scans were conducted before and after needle insertion. The high-risk clinical target volume (CTV-HR), including residual disease and suspicious regions, as well as normal tissues, was contoured. The dosimetry goal was to ensure that the reference isodose (100%) adequately covered the CTV-HR while minimizing overlap with organs at risk. The needle shifts were assessed according to their locations. Outcome measures, including disease-free survival and overall survival, were analyzed. RESULTS: A total of 64 fractions were administered, with Utrecht applicators used for 62.5% (n = 40). The median equivalent doses in 2 Gy fractions (EQD2 D90) for 90% of the CTV-HR and intermediate-risk CTV were 87.64 Gy (57.45-97.78 Gy) and 69 Gy (31.33-76.73 Gy), respectively. Among the 696 possible needle positions, 419 interstitial needles (60%) were successfully inserted. The median number of needles per fraction was 6 (range, 1-12). Needle shifts occurred in 93% of the patients, predominantly in the anteromedial direction, with a mean magnitude of 0.21 ± 0.14 cm. The median follow-up was 14 months, with a 90% local tumor control rate and an 85% overall survival rate over 2 years, without severe side effects. CONCLUSIONS: Despite challenges in treating vaginal cuff recurrence in patients with gynecological cancers, hybrid brachytherapy provides an effective and personalized approach. Although needle shifts are common, they do not significantly impact dosimetric outcomes, highlighting the method's adaptability and reliability.
PURPOSE: Eye plaque brachytherapy (EPBT) is not routinely performed on large uveal melanomas (UM) as commercially available plaques often cannot ensure adequate coverage of the tumor with high doses of 85 Gy. The purpose...PURPOSE: Eye plaque brachytherapy (EPBT) is not routinely performed on large uveal melanomas (UM) as commercially available plaques often cannot ensure adequate coverage of the tumor with high doses of 85 Gy. The purpose of this study is to report our institution's experience with a clinically novel approach of staged EPBT in treating large UM in 2 treatments, 45 Gy in each treatment. METHODS AND MATERIALS: Patients were included if they underwent staged EPBT at our institution between 2020 and 2023. RESULTS: A total of 13 patients with a median age of 65 were included in this study. All patients were treated with Iodine-125 with a first-stage prescription dose of 45 Gy and with a second-stage treatment occurring at median 13 weeks after with prescription dose of 45 Gy. Median follow-up was 42 months, and local control was 100% with no patients requiring an enucleation for a local recurrence or other radiation-related toxicities. At last follow-up, all tumors were decreased in size. Visual acuity worsened in 11 patients, and other radiation-related toxicities included cataract, cystoid macular edema, radiation retinopathy, and neovascular glaucoma. Three patients developed metastases, one of whom died shortly after, while all other patients were alive at last follow-up. CONCLUSIONS: Staged EPBT for large UM is a novel and feasible globe-preserving treatment with a high rate of local control. Ocular toxicities are expected but do not require enucleation. Further prospective randomized trials should be performed to validate this treatment approach.
PURPOSE: The central nervous system World Health Organization (WHO) grade 4 adult-type diffuse glioma represents one of the most aggressive and challenging primary brain tumors. This guideline aims to provide evidence-ba...PURPOSE: The central nervous system World Health Organization (WHO) grade 4 adult-type diffuse glioma represents one of the most aggressive and challenging primary brain tumors. This guideline aims to provide evidence-based recommendations for the multidisciplinary management of these tumors, focusing on diagnosis, initial treatment, reirradiation, and health disparities, while acknowledging that present literature primarily represents historical histologic grade 4 glioblastoma. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications for radiation therapy (RT) and/or adjunctive therapies (eg, systemic therapy, alternating electric field therapy), appropriate regimens for external beam RT after initial biopsy/resection including variables such as pretreatment characteristics, target volumes, technique, dose, reirradiation indications and techniques, and health disparities. Recommendations are based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Following maximum safe resection, molecular and pathologic diagnosis, and prognostic stratification of WHO grade 4 adult-type diffuse glioma, concurrent RT with temozolomide followed by adjuvant temozolomide is recommended for eligible patients and incorporation of alternating electric field therapy is conditionally recommended. In elderly patients, hypofractionated RT with concurrent and adjuvant temozolomide is conditionally recommended. In frail patients, supportive and palliative care is conditionally recommended following multidisciplinary, patient-centered discussion. Appropriate reirradiation techniques, with or without additional systemic therapies, can be considered and are conditionally recommended in patients following pathologic or advanced imaging confirmation of WHO grade 4 diffuse glioma recurrence. Health disparities exist in patients with WHO grade 4 adult-type diffuse glioma and attention is necessary to improve outcomes and increase clinical trial enrollment for underserved populations. CONCLUSIONS: These evidence-based recommendations and current practice adoption patterns inform best clinical practices on the management of WHO grade 4 adult-type diffuse glioma. Future advancements in personalized medicine, biomarker discovery, and novel therapies are essential to improving outcomes. The integration of multidisciplinary care and participation in future clinical trials, especially in underserved populations, is crucial in addressing the poor outcomes among WHO grade 4 adult-type diffuse glioma.