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PROGRESS IN CLINICAL NEUROSCIENCES: Advances in the Management of Low-Grade Gliomas

Published online by Cambridge University Press:  02 December 2014

Warren P. Mason
Warren P. Mason*
Affiliation:
Department of Medical Oncology & Hematology, Princess Margaret, Hospital, Toronto, Ontario,Canada
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Abstract

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The management of low-grade gliomas represents one of the most challenging and controversial areas in neuro-oncology. Many aspects of the treatment of low-grade gliomas are debated, including the optimal timing of surgery and radiotherapy, the benefit of extensive surgery, and the impact of these variables on the natural history of these indolent and generally incurable tumours. The recently published results of several large multicentre trials addressing the timing and dose of radiotherapy have provided solid evidence for delayed and reduced dose irradiation. These studies have also confirmed prognostic variables that can be used to guide management of individual patients. Among these variables is the observation that tumours with oligodendroglial features have a better natural history and response profile. The recognition that as many as two thirds of low-grade gliomas have oligodendroglial features, advances in molecular diagnostics making accurate pathologic diagnosis of oligodendroglial tumours possible, and the established chemosensitivity of malignant oligodendrogliomas, have raised new issues surrounding the potential value of chemotherapy for low-grade gliomas. This review will be restricted to low-grade diffuse astrocytomas, oligodendrogliomas, and low-grade mixed oligoastrocytomas in adults, and provide evidence-based guidelines for the management of these tumours, including the emerging role of chemotherapy as initial treatment.

Résumé:

RÉSUMÉ:

Le traitement des gliomes à faible malignitÉ demeure un des domaines les plus controversÉs en neuro-oncologie. Plusieurs aspects de leur traitement, soit le meilleur moment pour la chirurgie et la ratiothÉrapie, les bÉnÉfices d’une chirurgie extensive et l’impact de ces variables sur l’histoire naturelle de ces tumeurs indolentes et gÉnÉralement incurables, font l’objet de controverses. Les rÉsultats de plusieurs grandes Études multicentriques publiÉes rÉcemment sur le moment de l’administration et la dose de radiothÉrapie ont fourni des donnÉes solides favorisant une irradiation tardive, à faible dose. Ces Études ont Également confirmÉ que certaines variables sont utiles pour Établir un pronostic et peuvent être utilisÉes pour guider la prise en charge individuelle des patients. Il est bien Établi que les tumeurs qui ont des caractÉristiques oligodendrogliales ont une histoire naturelle plus favorable et une meilleure rÉponse au traitement. On sait maintenant que les deux-tiers des gliomes à faible malignitÉ ont des caractÉristiques oligodendrogliales. Les progrès effectuÉs dans le diagnostic molÉculaire, qui rendent possible un diagnostic anatomopathologique prÉcis dans les cas de tumeurs oligodendrogliales, et la chimiosensibilitÉ des oligodendrogliomes malins ont suscitÉ des discussions sur la valeur potentielle de la chimiothÉrapie dans les gliomes à faible malignitÉ Cette revue se limite aux astrocytomes diffus à faible malignitÉ, aux oligodendrogliomes et aux oligoastrocytomes mixtes à faible malignitÉ chez les adultes et fournit des lignes directrices basÉes sur des donnÉes probantes pour le traitement de ces tumeurs, particulièrement quant au rôle Émergeant de la chimiothÉrapie comme traitement initial.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 18 - 26
Copyright
Copyright © The Canadian Journal of Neurological 2014

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