Multidisciplinary management of adult low grade gliomas.

ABSTRACT

BACKGROUND: Adult hemispheric low grade gliomas (LGG) cover a pathologic spectrum which has specific clinical, histological and molecular characteristics. The optimal management of these tumors is still a controversial topic in international literature. METHODS: We evaluated scientific papers from the literature (Medline and Cochrane Library to date) and we compared the results found there with our experience, trying to create a pattern of treatment of our own. RESULTS AND CONCLUSIONS: The advances in microsurgical and neuromonitoring techniques, as well as in neuroimaging, allow for a more aggressive resection of LGG with a significant improvement in overall survival and quality of life. The potential risks of the "wait and see" policy and the neurotoxicity of radiotherapy are challenged by the benefits of careful surgical resection and up-front chemotherapy. The present day treatment strategy, based on recent evidence, should include a maximal surgical resection when possible, with the full preservation of the patients ability, and delayed radiotherapy. The role of temozolomide in the management of LGG and the identification of the therapeutic modality with the best quality of life profile will be determined by ongoing trials. The further characterization of prognostic relevance of molecular markers and data from advanced imaging techniques needs an intensification of research and validation efforts. ABBREVIATIONS LGG low grade gliomas, WHO World Health Organization, OS overall survival, PFS progression-free survival, MRI Magnetic resonance imaging, MRS Magnetic resonance spectroscopy, MPFS malignant progression-free survival, rCBV Relative Cerebral Blood Volume, QOL quality of life, FLAIR Fluid attenuated inversion recovery, MGMT O6-methylguanine DNA methyltransferase enzyme, DSC MR imaging Dynamic Susceptibility Contrast Perfusion MR imaging, 1H-MRS Proton Magnetic Resonance Spectroscopy, IDH1 isocitrate dehydrogenase 1 gene, SPECT Single-photon emission computed tomography, PET Positron emission tomography, DTI-FT Diffuse Tensor Imaging-fiber tracking technique, DES direct electrical stimulation, EEG Electroencephalography, EcoG Electrocorticography, MEP motor evoked potentials, EMG Electromyography, AED anti-epileptic drugs, TMZ Temozolomide, EORTC European Organization for Research and Treatment of Cancer, NCCTG North Central Cancer Treatment Group, RTOG Radiation Therapy Oncology Group, ECOG Eastern Cooperative Oncology Group, EOR extent of resection, Gy Gray (unit), GyE gray equivalent, RT radiation therapy, IMRT image-guided intensity modulated radiotherapy, FSRT fractionated stereotactic radiotherapy, SRS proton therapy or stereotactic radiosurgery, LET high-linear energy transfer beams, RBE relative biological effectiveness, CTCAE Common Terminology Criteria for Adverse Events, PCV procarbazine, lomustine, and vincristine chemotherapy.