The management of patients suffering from low-grade gliomas (LGGs) remains a challenge in absence of a definite curative therapy. The median survival is highly variable, from 2 years (high-risk disease) to over 15 years (low risk). The aim of this review is to provide a practical step-by-step evaluation of the available treatment options for patients with LGGs.
Next to clinical prognostic markers, both the isocitrate dehydrogenase (IDH) mutation status and the status of 1p/19q codeletion are key prognostic factors for the optimal management of patients with LGG. Two recent randomized phase III clinical trials were performed in LGGs. They first compared the efficacy of radiation versus temozolomide (TMZ) chemotherapy in high-risk LGGs. The second trial compared radiation versus radiation combined with procarbazine, lomustine and vincristine chemotherapy.
Regarding molecular prognostic factors, IDH wild-type LGGs have the worst prognosis, independent of therapy, whereas patients with mutated IDH, codeleted 1p/19q LGGs fared best regarding progression-free survival (PFS). In high-risk LGGs, PFS is similar regardless of whether patients have been treated with radiation or TMZ. In the second trial, patients who were treated with combination radiation and chemotherapy showed significant longer overall survival.
aDepartment of Clinical Neurosciences
bDepartment of Oncology, Centre Hospitalier Universitaire Vaudois & Lausanne University, Lausanne, Switzerland
cDepartment of Radiation-Oncology (MAASTRO), Maastricht University Medical Center (MUMC) and GROW (School for Oncology), Maastricht, Netherlands
dDepartment of Radiation-Oncology, MediClin Robert-Janker-Clinic & Clinical Cooperation Unit Neurooncology, University Bonn Medical Centre, Bonn, Germany
*Andreas F. Hottinger, Monika E. Hegi and Brigitta G. Baumert contributed equally to the article.
Correspondence to Andreas F. Hottinger, Centre Hospitalier Universitaire Vaudois, Departments of Clinical Neurosciences and Oncology, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 21 314 0168; fax: +41 21 314 0737; e-mail: Andreas.email@example.com