title: Current Management of Adult Diffuse Infiltrative Low Grade Gliomas.
abstract: Diffuse infiltrative low grade gliomas (LGG) account for approximately 15 % of all gliomas. The prognosis of LGG differs between high-risk and low-risk patients notwithstanding varying definitions of what constitutes a high-risk patient. Maximal safe resection optimally is the initial treatment. Surgery that achieves a large volume resection improves both progression-free and overall survival. Based on results of three randomized clinical trials (RCT), radiotherapy (RT) may be deferred in patients with low-risk LGG (defined as age <40 years and having undergone a complete resection), although combined chemoradiotherapy has never been prospectively evaluated in the low-risk population. The recent RTOG 9802 RCT established a new standard of care in high-risk patients (defined as age >40 years or incomplete resection) by demonstrating a nearly twofold improvement in overall survival with the addition of PCV (procarbazine, CCNU, vincristine) chemotherapy following RT as compared to RT alone. Chemotherapy alone as a treatment of LGG may result in less toxicity than RT; however, this has only been prospectively studied once (EORTC 22033) in high-risk patients. A challenge remains to define when an aggressive treatment improves survival without impacting quality of life (QoL) or neurocognitive function and when an effective treatment can be delayed in order to preserve QoL without impacting survival. Current WHO histopathological classification is poorly predictive of outcome in patients with LGG. The integration of molecular biomarkers with histology will lead to an improved classification that more accurately reflects underlying tumor biology, prognosis, and hopefully best therapy.
authors.affiliation: Neuro-oncology, Department of Neurosurgery, Lille University Hospital, Lille, France. emilie.lerhun@chru-lille.fr.|Breast unit, Department of Medical Oncology, Oscar Lambret Center, Lille, France. emilie.lerhun@chru-lille.fr.|PRISM Inserm U1191, Villeneuve d'Ascq, France. emilie.lerhun@chru-lille.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: Department of Neurology, Pitié-Salpétrière Hospital, UPMC-Paris VI University, Paris, France. sophie.taillibert@gmail.com.|Department of Radiation Oncology, Pitié-Salpétrière Hospital, UPMC-Paris VI University, Paris, France. sophie.taillibert@gmail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Taillibert
authors.affiliation: Division of Neuro-Oncology, Department of Neurology and Neurological Surgery, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Ave E, MS G4940, PO Box 19023, Seattle, WA, 98109, USA. chambemc@seattlecca.org.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Chamberlain
mesh_terms: D000328:Adult; D005910:Glioma / Q000473:pathology; D006801:Humans; D011379:Prognosis; D011788:Quality of Life
keywords: Low grade glioma; Molecular classification and biomarkers; Neurocognitive function; Randomized clinical trials