Summary and Further Reading

Chapter 5 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

Summary

  • The optimal management of LGGs remains controversial
  • To date, no compelling evidence demonstrates that early intervention with surgery improves outcome over observation in low-grade gliomas
  • The current evidence supports treating patients with LGG based on their molecular and clinial characteristics: intensive therapeutic strategies for poor-prognosis patients while avoiding overtreatment in indolent disease
  • For a slowly proliferating tumour causing few or no symptoms and in a patient with a low-risk profile, a watch-and-wait policy may be adequate
  • Once progression is established, maximal safe resection should be favoured over biopsy
  • Significant differences in outcome between molecular subgroups have led to the integration of molecular markers into the 2016 WHO classification of brain tumours
  • IDH mutated, 1p/19q codeleted LGGs present the best prognosis, IDH wildtype LGGs the worst
  • Younger age, smaller tumour, absence of neurological symptoms, oligodendroglial histology, presence of 1p/19q codeletion and IDH mutation are favourable prognostic factors
  • If it is decided that the patient must be treated after surgery, options include RT, ChT or a combination of both. Recent data suggest that a combination of RT followed by ChT is superior to RT alone
  • Direct postoperative monotherapy with RT probably improves PFS, but not OS

Further Reading

Baumert BG, Hegi ME, van den Bent MJ, et al. Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 2016; 17:1521–1532.

Buckner JC, Chakravarti A, Curran WJ Jr. Radiation plus chemotherapy in low-grade glioma. N Engl J Med 2016; 375:490–491.

Chang SM, Cahill DP, Aldape KD, Mehta MP. Treatment of adult lower-grade glioma in the era of genomic medicine. Am Soc Clin Oncol Educ Book 2016; 35:75–81.

Gorlia T, Wu W, Wang M, et al. New validated prognostic models and prognostic calculators in patients with low-grade gliomas diagnosed by central pathology review: a pooled analysis of EORTC/RTOG/NCCTG phase III clinical trials. Neuro Oncol 2013; 15:1568– 1579.

Laack NN, Brown PD, Ivnik RJ, et al; North Central Cancer Treatment Group. Cognitive function after radiotherapy for supratentorial low- grade glioma: a North Central Cancer Treatment Group prospective study. Int J Radiat Oncol Biol Phys 2005; 63:1175–1183.

Ryken TC, Parney I, Buatti J, et al. The role of radiotherapy in the management of patients with diffuse low grade glioma: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2015; 125:551–583.

Soffietti R, Baumert BG, Bello L, et al; European Federation of Neurological Societies. Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force. Eur J Neurol 2010; 17:1124–1133.

van den Bent MJ, Afra D, de Witte O, et al; EORTC Radiotherapy and Brain Tumor Groups and the UK Medical Research Council. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 2005; 366:985–990.

van den Bent MJ. Chemotherapy for low-grade glioma: when, for whom, which regimen? Curr Opin Neurol 2015; 28:633–938.

Ziu M, Kalkanis SN, Gilbert M, et al. The role of initial chemotherapy for the treatment of adults with diffuse low grade glioma: a systematic review and evidence-based clinical practice guideline. J Neurooncol 2015; 125:585–607.

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Last update: 18 September 2017