Management of low-grade glioma

Abstract

The optimal management of patients with low-grade glioma (LGG) is controversial. The controversy largely stems from the lack of well-designed clinical trials with adequate follow-up to account for the relatively long progression-free survival and overall survival of patients with LGG. Nonetheless, the literature increasingly suggests that expectant management is no longer optimal. Rather, there is mounting evidence supporting active management including consideration of surgical resection, radiotherapy, chemotherapy, molecular and histopathologic characterization, and use of modern imaging techniques for monitoring and prognostication. In particular, there is growing evidence favoring extensive surgical resection and increasing interest in the role of chemotherapy (especially temozolomide) in the management of these tumors. In this review, we critically analyze emerging trends in the literature with respect to management of LGG, with particular emphasis on reports published during the past year.

Fig. 1

Management of low-grade glioma (LGG). This flow diagram outlines a standard scheme for managing LGG, emphasizing the need to evaluate patients for surgical resection as one of the first steps in the comprehensive, multidisciplinary management of these tumors. This algorithm necessitates tissue acquisition for management in most cases, except for patients who are low risk and those who are asymptomatic. Once LGG has been confirmed, management varies depending on risk stratification of the patient, as described in Table 1. It is noteworthy that radiation therapy is delayed until the time of progression. ^aTemozolomide should be considered for treatment of high-risk patients when there is evidence of codeletion of 1p/19q or in the setting of a clinical trial