[Management of low-grade gliomas]

A better understanding of the natural history of World Health Organization (WHO) grade-II gliomas (ie the regular progression, the infiltration along white matter tracts and especially the risk of anaplastic transformation, which are function- or life-threatening), associated with reduced treatment risks, has modified the standard "no-treatment" approach in a resolutely therapeutic approach. From now on, the aim is to work towards the elaboration of real therapeutic strategies adapted to each patient, ie to determine the sequence and timing for each treatment (first or even second surgical excision, first or even second line of chemotherapy, radiotherapy) according to tumour progression (assessed using routine MRI examinations), according to the clinical and neuropsychological status as well as to the individual brain anatomic and functional organization (assessed with mapping techniques). The objective is to avoid malignant transformation as long as possible while preserving the quality of life, since this tumour mostly occurs in young patients having a family life and a regular social and professional activity.