Clinical Presentation and Clinical Prognostic Markers

Chapter 5 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

LGGs account for 5%–10% of all gliomas and typically arise in individuals aged 30–50 years. Most patients present with seizures only and show no other neurological deficit.

MRI appearance may be highly suggestive for the presence of a LGG. The majority of LGGs show T2 hyperintensity, without uptake of contrast media.

Comparison of imaging (MRI, FLAIR [fluid attenuation inversion recovery] sequences) over long periods of time (typically >1 year) will show progression.

Factors associated with worse outcome include:

  • Age ≥40 years
  • Astrocytic histology
  • Tumours ≥5 cm
  • Tumour crossing the midline
  • Neurological deficit before surgery

The European Organisation for Research and Treatment of Cancer (EORTC) developed a clinical prognostic score, based on two randomised, multicentre trials: EORTC 22844 and 22845.

This score defined 0 to 5 points as unfavourable prognostic factors. Survival decreased with each unfavourable factor.

Patients with unfavourable risk factors should be treated, while patients with mainly favourable prognostic factors may not need immediate treatment; a watch-and-wait strategy is an option.

Revision Questions

  1. What is the typical appearance of LGG on MRI?
  2. Why is it not sufficient to compare MRI images over a 3–6 month period for LGG?
  3. What defines a “high risk“ LGG patient?

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Last update: 18 September 2017