Contemporary management of low-­grade glioma: a paradigm shift in neuro-oncology

Abstract

Supratentorial diffuse intrinsic low-grade gliomas represent a distinct but heterogenous group of tumours, with the propensity to grow and to differentiate into malignant tumours. They have been historically viewed in the 'benign' spectrum of intrinsic brain tumours, so a watch-and-wait policy was often adopted. With recent advances in our understanding of the natural history of these tumours, combined with advances in surgical technique, an aggressive approach is now recommended. Increasing quality evidence of the impact of tumour resection and multicentre trials of adjuvant radiotherapy and chemotherapy have led to a new algorithm for low-grade glioma management. This review aims to outline the emerging evidence that has shifted neuro-oncology practice.

A man having a convulsion

“…Eighty per cent of patients with low grade glioma present with seizures 4. Absence of enhancement on MRI is also suggestive of low grade glioma.…”

“…Aggressive surgical resection is the recommended treatment modality; it provides relief from increased intracranial pressure symptoms, leading to seizure control, and reducing the need for anti-epileptic drugs 4. During surgery, tissue for a histological diagnosis can also be obtained.…”

Imaging in low-grade glioma: a guide for neurologists

“…As outlined in Caroline Hayhurst’s Practical Neurology review,1 we now widely recognise the importance of molecular genetics in the pathogenesis of gliomas. With this new knowledge, the 2016 update to the WHO Classification of Tumours of the Central Nervous System dramatically changed its approach to LGG classification.…”

“…This coupled with the recent 2016 update to the World Health Organisation Classification of Tumours of the Central Nervous System is changing LGG imaging and management. Recently in Practical Neurology the contemporary management of low-grade glioma and the changes to this grading system were discussed in detail 1 . In this complementary article, we discuss the role of imaging in the diagnosis, surgical planning and post-treatment follow-up of LGG.…”

Highlights from this issue

“…The management of low-grade gliomas is changing from a ‘wait and see’ to one of early intervention 1. The difficulty is that patients present with a seizure, or sometimes with an incidental finding, and then all the management decisions depend primarily on the radiological findings and thedisorder into its clinical context recently described clinical ir interpretation.…”