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Management of low-grade glioma

Lawrence D Recht, MD
Martin van den Bent, MD, PhD
Helen A Shih, MD
Section Editors
Patrick Y Wen, MD
Jay S Loeffler, MD
Deputy Editor
April F Eichler, MD, MPH


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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Literature review current through: Nov 2017. | This topic last updated: Oct 03, 2017.
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