Low grade gliomas of childhood: the actual management

Low grade gliomas (LGG) are the most common brain tumors of childhood and adolescence, consisting of a mixed group of grade I and grade II neoplasms. In general, their location and resectability are the most important predictors of outcome. Surgery is curative, usually for superficial tumors of the cerebral or cerebellar hemispheres, but has a more controversial role for deep-seated midline tumors. Where gross total resection is not feasible, LGG becomes a chronic disease of childhood, and adjuvant therapies must be tailored for each individual based on age and tumor location. Radiotherapy (RT) is effective but associated with neurological, cognitive, and endocrinological morbidity, prompting the use of chemotherapy regimens aimed at delaying RT, especially in younger children. Long-term surveillance imaging for up to five years after treatment is warranted even after gross total resection, and lifelong surveillance is warranted after RT because of iatrogenic effects. Despite a favorable prognosis for survival, LGG are associated with disability, decreased quality of life, and late effects of treatment, all requiring long-term specialty care through a multidisciplinary approach.