TN 22 (12-18)

DI 23022.735 Glioma - Grade III and IV

COMPASSIONATE ALLOWANCE INFORMATION

GLIOMA – GRADE III and IV

ALTERNATE NAMES

High Grade Malignant Glioma; Malignant Glioma Grade III; Malignant Glioma Grade IV; Glioblastoma; Anaplastic Astrocytoma; Undifferentiated Glioma; Anaplastic Glioma; Anaplastic Oligodendroglioma; Anaplastic Oligoastrocytoma; Giant Cell Glioblastoma; Gliosarcoma; Epithelioid Glioblastoma; Diffuse Midline Glioma

DESCRIPTION

Glioma is a broad category of brain and spinal cord tumors that come from glial cells, the main brain cells that can develop into cancer. Approximately 80% of malignant brain tumors are gliomas. These gliomas are categorized as ependymomas, astrocytomas or oligodendrogliomas. The exact cause of malignant gliomas is unknown.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: MRI is the preferred diagnostic tool, however malignant gliomas are also diagnosed by CT scan and biopsy. Biopsy is often needed to establish the grade of the glioma.

Physical findings: Common signs and symptoms of malignant gliomas include:

• Headache;

• Nausea or vomiting;

• Confusion or a decline in brain function;

• Memory loss;

• Personality changes or irritability;

• Difficulty with balance;

• Urinary incontinence;

• Vision problems, such as blurred vision, double vision or loss of peripheral vision;

• Speech difficulties; and

• Seizures, especially in someone without a history of seizures.

ICD9: 191.0-9

PROGRESSION

Malignant gliomas can develop at any age. They tend to grow and become more malignant over time. The peak incidence generally occurs in the fifth and sixth decade of life. Prognosis is often poor for individuals with grades III and IV tumors with the average survival time approximately 12 months. Few individuals survive beyond three years with conventional treatment.

TREATMENT

Treatment depends on the location of the tumor and its progression. These tumors tend to grow or infiltrate into the normal brain tissue. Standard treatment is surgery followed by radiation therapy. If surgery is not an option, radiation therapy is given. Chemotherapy is sometimes given during or after radiation therapy.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Pathology report documenting type and stage of tumor;

  • Operative reports; and

  • MRI or CT scans.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.13A1&2

Grade III and IV gliomas meet the criteria in listing 13.13 A 1 & 2 upon confirmed diagnosis, regardless of effectiveness of treatment. Recurrent malignant gliomas meet 13.13A3 upon confirmed diagnosis, regardless of grade and effectiveness of treatment.

113.13A&B

Grade III and IV gliomas meet the criteria in listing 113.13 A & B upon confirmed diagnosis, regardless of effectiveness of treatment.

Equals

 

 

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022735
DI 23022.735 - Glioma - Grade III and IV - 12/28/2018
Batch run: 12/28/2018
Rev:12/28/2018