Management of low-grade glioma
- Lawrence D Recht, MD
Lawrence D Recht, MD
- Professor of Neurology
- Stanford University School of Medicine
- Martin van den Bent, MD, PhD
Martin van den Bent, MD, PhD
- Daniel den Hoed Oncology Center
- Neuro-Oncology Unit
- Helen A Shih, MD
Helen A Shih, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- Attending Radiation Oncologist
- Massachusetts General Hospital
- Section Editors
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
Low-grade gliomas can be divided into several distinct entities based upon their molecular and histopathologic features (table 1). These differences correlate with important differences in biologic behavior and thus have important implications for patient management. Low-grade gliomas can develop anywhere in the central nervous system, although studies usually are directed to a particular location (eg, cerebral hemispheres, optic pathways, brainstem).
Low-grade gliomas have a protracted natural history, which often terminates with transformation into high-grade gliomas. The goals of treatment for patients with these tumors include prolonging overall and progression-free survival and minimizing morbidity. This requires preventing tumor enlargement and transformation into high-grade glioma and minimizing treatment-related complications.
Surgery, radiation therapy (RT), and chemotherapy all have a role in the management of these tumors, but their indolent natural history has resulted in a number of areas of uncertainty. Areas of controversy in the management of these patients include the following:
●An aggressive treatment approach including immediate surgical intervention versus a delayed intervention in patients with limited disease and symptoms
●The role and timing of RT and/or chemotherapy (ie, administered immediately after surgery versus delayed until there is evidence of recurrent or progressive disease)
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- Timing of resection
- Extent of resection
- POSTOPERATIVE THERAPY
- IDH-wildtype tumors
- IDH-mutant tumors
- - General approach
- Radiation therapy
- - Timing of radiation
- - Dose and schedule
- - Side effects
- Adjunctive chemotherapy
- Chemotherapy with deferred RT
- RECURRENT DISEASE
- Radiation therapy
- SUPPORTIVE CARE
- Cognitive rehabilitation
- SURVEILLANCE AFTER TREATMENT
- PROGNOSIS AND NATURAL HISTORY
- PILOCYTIC ASTROCYTOMAS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS