Treatment: Radiotherapy

Chapter 5 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

For patients presenting with seizures only and with typical radiographic features of LGG, follow-up can consist of serial MRIs.

In the presence of unfavourable prognostic factors or progressive disease on MRI, treatment is warranted.

The first step should be surgery to obtain tissue for establishing a definite diagnosis. Maximal safe resection should be aimed for, whenever feasible.

Once the diagnosis is established, the optimal management of patients with LGGs remains challenging and controversial, as neither timing nor sequence of treatment have been unambiguously resolved.

Postoperative follow-up may be an option for some patients. This approach is supported by the results of EORTC Trial 22845, which showed similar overall survival (OS) for patients having radiotherapy (RT) or “simple” follow-up (although progression-free survival [PFS] was in favour of RT).

Current accepted standard doses for radiation are 50.4–54 Gy in fractions of 1.8 Gy.

Early RT also resulted in significantly better control and improvement of epilepsy at 1 year (EORTC 22845), compared to delayed RT.

The main concern with RT is long-term cognitive sequelae. However, most adverse effects of RT are linked to higher total doses, larger treatment fields and older RT techniques. With modern RT techniques (intensity-modulated RT [IMRT], stereotactic RT, image-guided RT) and doses, limited neurocognitive damage is expected.

Revision Questions

  1. Can surgery be delayed in patients with LGGs?
  2. What is the accepted standard RT dose?
  3. Does RT alone improve survival in LGG patients?

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Last update: 18 September 2017