title: Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force.
abstract: BACKGROUND
  Diffuse infiltrative low-grade gliomas of the cerebral hemispheres in the adult are a group of tumors with distinct clinical, histological and molecular characteristics, and there are still controversies in management.
  
  
  METHODS
  The scientific evidence of papers collected from the literature was evaluated and graded according to EFNS guidelines, and recommendations were given accordingly.
  
  
  CONCLUSIONS
  WHO classification recognizes grade II astrocytomas, oligodendrogliomas and oligoastrocytomas. Conventional MRI is used for differential diagnosis, guiding surgery, planning radiotherapy and monitoring treatment response. Advanced imaging techniques can increase the diagnostic accuracy. Younger age, normal neurological examination, oligodendroglial histology and 1p loss are favorable prognostic factors. Prophylactic antiepileptic drugs are not useful, whilst there is no evidence that one drug is better than the others. Total/near total resection can improve seizure control, progression-free and overall survival, whilst reducing the risk of malignant transformation. Early post-operative radiotherapy improves progression-free but not overall survival. Low doses of radiation are as effective as high doses and better tolerated. Modern radiotherapy techniques reduce the risk of late cognitive deficits. Chemotherapy can be useful both at recurrence after radiotherapy and as initial treatment after surgery to delay the risk of late neurotoxicity from large-field radiotherapy. Neurocognitive deficits are frequent and can be caused by the tumor itself, tumor-related epilepsy, treatments and psychological distress.
authors: Department of Neuroscience, University Hospital San Giovanni Battista, Turin, Italy.
authors: R
authors: R
authors: Soffietti
authors: Department of Radiation-Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht University Medical Center (MUMC), The Netherlands.
authors: B G
authors: BG
authors: Baumert
authors: Department of Neurological Sciences, Neurosurgery, University, Milan, Italy.
authors: L
authors: L
authors: Bello
authors: Department of Neuropathology, University, Heidelberg, Germany.
authors: A
authors: A
authors: Von Deimling
authors: Department of Neurosurgery, Hôspital Guide Chauliac, Montpellier, France.
authors: H
authors: H
authors: Duffau
authors: Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France.
authors: M
authors: M
authors: Frénay
authors: Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors: W
authors: W
authors: Grisold
authors: Centre for Neuro-Oncology, Western General Hospital, Edinburgh, UK.
authors: R
authors: R
authors: Grant
authors: Service of Neurology, Hospital Clinic, Barcelona, Spain.
authors: F
authors: F
authors: Graus
authors: Service de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors: K
authors: K
authors: Hoang-Xuan
authors: Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors: M
authors: M
authors: Klein
authors: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
authors: B
authors: B
authors: Melin
authors: National Hospital for Neurology and Neurosurgery, London, UK.
authors: J
authors: J
authors: Rees
authors: Center for Neuro-Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors: T
authors: T
authors: Siegal
authors: Department of Neuroscience, Neurology, University Hospital, Uppsala, Sweden.
authors: A
authors: A
authors: Smits
authors: Department of Neurosurgery, Medical Oncology, University Hospital, Lausanne, Switzerland.
authors: R
authors: R
authors: Stupp
authors: Department of Neurooncology, University, Heidelberg, Germany.
authors: W
authors: W
authors: Wick
mesh_terms: D026683:Advisory Committees / Q000639:trends*; D024221:Antineoplastic Protocols / Q000592:standards*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D005060:Europe; D019317:Evidence-Based Medicine / Q000639:trends; D005910:Glioma / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards; D011379:Prognosis