title: Diffuse low-grade glioma: a review on the new molecular classification, natural history and current management strategies.
abstract: The management of diffuse supratentorial WHO grade II glioma remains a challenge because of the infiltrative nature of the tumor, which precludes curative therapy after total or even supratotal resection. When possible, functional-guided resection is the preferred initial treatment. Total and subtotal resections correlate with increased overall survival. High-risk patients (age >40, partial resection), especially IDH-mutated and 1p19q-codeleted oligodendroglial lesions, benefit from surgery plus adjuvant chemoradiation. Under the new 2016 WHO brain tumor classification, which now incorporates molecular parameters, all diffusely infiltrating gliomas are grouped together since they share specific genetic mutations and prognostic factors. Although low-grade gliomas cannot be regarded as benign tumors, large observational studies have shown that median survival can actually be doubled if an early, aggressive, multi-stage and personalized therapy is applied, as compared to prior wait-and-see policy series. Patients need an honest long-term therapeutic strategy that should ideally anticipate neurological, cognitive and histopathologic worsening.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain. pedrodl@yahoo.com.
authors.forename: P D
authors.initials: PD
authors.lastname: Delgado-López
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: Corrales-García
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martino
authors.affiliation: Servicio de Oncología Médica, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Lastra-Aras
authors.affiliation: Servicio de Oncología Radioterápica, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Dueñas-Polo
mesh_terms: D001932:Brain Neoplasms / Q000145:classification* / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D019468:Disease Management; D005910:Glioma / Q000145:classification* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D060787:Neoplasm Grading
keywords: Astrocytoma; Chemotherapy; Low-grade glioma; Natural history; Oligodendroglioma; Radiotherapy; Supratotal resection; WHO glioma classification