Current management of low-grade gliomas.
- Hottinger AF 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.
- Hegi ME
- Baumert BG
- 2016-09-28
Published in:
- Current opinion in neurology. - 2016
Antineoplastic Agents, Alkylating
Brain Neoplasms
Combined Modality Therapy
Dacarbazine
Disease-Free Survival
Glioma
Humans
Mutation
Prognosis
Temozolomide
Treatment Outcome
English
PURPOSE OF REVIEW
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.
RECENT FINDINGS
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.
SUMMARY
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.
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.
RECENT FINDINGS
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.
SUMMARY
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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1097/WCO.0000000000000390
- PMID 27676279
- Persistent URL
- https://sonar.ch/global/documents/20459
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