To provide optimal patient care, clinicians need to be well informed about the factors affecting the selection of the appropriate tests, the nuances of analyzing and interpreting complex test results in order to select the most appropriate treatment for their patients, and how to communicate with patients about the results.

With the use of genetic and molecular testing, gliomas can be differentiated more accurately in terms of prognosis and, in some instances, response to different therapies. The updated WHO classification of tumors of the central nervous system (CNS) takes into account the importance of molecular data for accurately diagnosing CNS tumors. Detection of genetic or epigenetic alterations could expand clinical trial options for a patient with a brain tumor.

Whole-brain radiation therapy was historically the mainstay of treatment for brain metastases but has fallen out of favor in clinical practice over the last several decades. Strategies to promote cognitive preservation in patients with brain metastases is an area of active investigation. Clinicians need to remain up to date on these strategies.

As a result of advances in diagnosis and treatment, many patients improve with proper management and do not die of progression of these metastatic lesions. As CNS-active systemic agents are changing paradigms for the management of brain metastases, it is important to acknowledge that there is a paucity of prospective data to characterize optimal strategies regarding radiation and systemic therapy combinations or sequencing.

These NCCN Guidelines Insights summarize the panel’s most recent recommendations regarding molecular profiling of gliomas.