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Review
. 2020 Oct 16;12(10):3008.
doi: 10.3390/cancers12103008.

Clinical Management of Diffuse Low-Grade Gliomas

Giuseppe Lombardi  1 , Valeria Barresi  2 , Antonella Castellano  3 , Emeline Tabouret  4 , Francesco Pasqualetti  5 , Alessandro Salvalaggio  6   7 , Giulia Cerretti  1 , Mario Caccese  1 , Marta Padovan  1 , Vittorina Zagonel  1 , Tamara Ius  8
Affiliations
Review

Clinical Management of Diffuse Low-Grade Gliomas

Giuseppe Lombardi et al. Cancers (Basel). .

Abstract

Diffuse low-grade gliomas (LGG) represent a heterogeneous group of primary brain tumors arising from supporting glial cells and usually affecting young adults. Advances in the knowledge of molecular profile of these tumors, including mutations in the isocitrate dehydrogenase genes, or 1p/19q codeletion, and in neuroradiological techniques have contributed to the diagnosis, prognostic stratification, and follow-up of these tumors. Optimal post-operative management of LGG is still controversial, though radiation therapy and chemotherapy remain the optimal treatments after surgical resection in selected patients. In this review, we report the most important and recent research on clinical and molecular features, new neuroradiological techniques, the different therapeutic modalities, and new opportunities for personalized targeted therapy and supportive care.

Keywords: chemotherapy; diffuse low-grade gliomas; radiotherapy; surgery; targeted therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Morphological and immunohistochemical features of IDH (isocitrate dehydrogenase) mutant astrocytoma and oligodendroglioma (original magnification × 100). Oligodendroglioma is characterized by rounded monomorphic nuclei, while astrocytoma has oval nuclei and mild pleomorphism. Both these cases have IDH1 R132H mutation, which is detectable by immunohistochemistry. However, astrocytoma has ATRX immunohistochemical loss and P53 diffuse staining as a consequence of mutations in these genes, while on the other hand oligodendroglioma, which lacks mutations in these genes, retains ATRX expression and is immuno-negative for P53.
Figure 2
Figure 2
H3 K27M mutated midline glioma (original magnification × 200). (A): Microscopic appearance with morphological features of a diffuse astrocytoma. (B): Nuclear immunohistochemical stain for H3 K27M protein.
Figure 2
Figure 2
H3 K27M mutated midline glioma (original magnification × 200). (A): Microscopic appearance with morphological features of a diffuse astrocytoma. (B): Nuclear immunohistochemical stain for H3 K27M protein.
Figure 3
Figure 3
Current algorithm of LGG clinical management. LGG: low.grade glioma; RT: radiotherapy; TMZ: temozolomide; PCV: procarbazine, CCNU, Vincristine; IDH wt = IDH wild-type; PD: progressive disease.
See this image and copyright information in PMC

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