What Have We Learned from Recent Clinical Studies in Low-Grade Gliomas?
Roberta Rudà1, Francesco Bruno2, Riccardo Soffietti2
1Department of Neuro-Oncology, University and City of Health and Science, Via Cherasco 15, 10126, Turin, Italy. rudarob@hotmail.com.
Purpose Of Review:
The management of low-grade gliomas (grade II WHO) is still controversial, due to the rarity of these tumors and continuous advances in molecular diagnosis and new technologies for treatment. This article reviews the current understanding of management of grade II gliomas in light of the recent clinical and translational studies.
Recent Findings:
The role of an extensive surgery at onset is now fully recognized. Recent clinical trials in the USA and Europe have demonstrated the importance of chemotherapy either in association with radiotherapy or as initial treatment to delay the risk of cognitive defects following radiation. Molecular factors, such as IDH1 or 2 mutations and 1p/19q codeletion, are favorable prognostic factors, and seem to predict a better response to chemotherapy as well. The role of conventional therapeutic options (surgery, radiotherapy, chemotherapy), in various combinations or sequences, has been better defined by clinical trials, but still there are areas of controversy. A future challenge is to reevaluate the role of these options within the different molecular subgroups of prognostic significance according to the last WHO classification of CNS tumors of 2016.
Insights
Management of low-grade gliomas (grade II WHO) is complex. Extensive surgery, chemotherapy, and radiotherapy are key, with molecular factors like IDH mutations guiding treatment decisions.
Area of Science:
- Neuro-oncology
- Molecular diagnostics
- Neurosurgery
Background:
- Management of World Health Organization (WHO) grade II gliomas remains controversial.
- Tumor rarity and evolving diagnostic/treatment technologies complicate decision-making.
Purpose of the Study:
- To review current understanding of grade II glioma management.
- Incorporate recent clinical and translational research findings.
Main Methods:
- Review of recent clinical trials and translational studies.
- Analysis of established and emerging therapeutic strategies.
Main Results:
- Extensive initial surgery is recognized as crucial.
- Chemotherapy, with or without radiotherapy, can mitigate cognitive risks.
- IDH1/2 mutations and 1p/19q codeletion are favorable prognostic markers, predicting chemotherapy response.
Conclusions:
- Conventional treatments (surgery, radiotherapy, chemotherapy) roles are better defined but still debated.
- Future strategies must integrate molecular subgroups (per 2016 WHO classification) for personalized management.
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