Low-Grade Gliomas

Abstract

Low-grade gliomas (LGGs) are a diverse group of primary brain tumors that often arise in young, otherwise healthy patients and generally have an indolent course with longerterm survival in comparison with high-grade gliomas. Treatment options include observation, surgery, radiation, chemotherapy, or a combined approach, and management is individualized based on tumor location, histology, molecular profile, and patient characteristics. Moreover, in this type of brain tumor with a relatively good prognosis and prolonged survival, the potential benefits of treatment must be carefully weighed against potential treatmentrelated risks.We review in this article current management strategies for LGG, including surgery, radiotherapy, and chemotherapy. In addition,the importance of profiling the genetic and molecular properties of LGGs in the development of targeted anticancer therapies is also reviewed. Finally, given the prevalence of these tumors in otherwise healthy young patients, the impact of treatment on neurocognitive function and quality of life is also evaluated. The Oncologist 2014;19:403-413Implications for Practice: This review summarizes the epidemiology, presentation, diagnosis, and treatment of low-grade gliomas. The article discusses recent advances in genetic characterization of these tumors, which has become particularly important in guiding tumor identification and classification, and may in some cases offer information about prognosis and/or expected response to treatment.The major studies regarding the use of radiation, chemotherapy, and surgical approaches in the treatment of these tumors are discussed.This information will aid medical oncologists in understanding the challenges inherent in diagnosing and treating patients with low-grade gliomas, and in recognizing the important factors to consider in devising treatment plans.

Procarbazine, Lomustine and Vincristine Toxicity in Low-Grade Gliomas

“…Midline shift, large tumour diameter, and astrocytic component to the tumour have also been reported as bad prognostic factors [3][4][5] . Histologically, the presence of the 2 mutations, 1p19q and IDH1, have been identified as factors with a favourable prognosis 6,7 . The documentation of the impact of these mutations on the clinical course of glioma patients has led to a change in the World Health Organisation (who) classification in 2007 8 .…”

Dynamic Contrast‐Enhanced MRI in Low‐Grade Versus Anaplastic Oligodendrogliomas

“…Initial treatment of anaplastic oligodendrogliomas usually involves tumor resection, adjuvant radiation, and often chemotherapy . In contrast, patients with low‐grade oligodendrogliomas typically undergo less treatment and survive longer than patients with anaplastic tumors . Accurate determination of tumor grade in patients with oligodendrogliomas is therefore clinically relevant.…”

“…3 In contrast, patients with low-grade oligodendrogliomas typically undergo less treatment and survive longer than patients with anaplastic tumors. 4 Accurate determination of tumor grade in patients with oligodendrogliomas is therefore clinically relevant. The current standard for glioma grading is histopathologic analysis.…”

Prediction of anaplastic transformation in low-grade oligodendrogliomas based on magnetic resonance spectroscopy and 1p/19q codeletion status

“…Among the different types of LGGs, grade II oligodendrogliomas have a better prognosis; nevertheless, these tumors, as for all LGGs, ineluctably undergo anaplastic transformation, which is associated with a poor prognosis [2]. Many patients with low-grade oligodendrogliomas, particularly those patients in whom a large surgical resection has been performed, can be managed with an initial approach consisting of a close follow-up without radiotherapy or chemotherapy [3][4][5][6][7][8].…”