15. Management of Low-Grade Gliomas

  1. Nils Erik Gilhus MD, PHD17,18,
  2. Michael P. Barnes MD, FRCP19,20 and
  3. Michael Brainin MD21,22,23
  1. R. Soffietti1,
  2. B. Baumert2,
  3. L. Bello3,
  4. A. von Deimling4,
  5. H. Duffau5,
  6. M. Frénay6,
  7. W. Grisold7,
  8. R. Grant8,
  9. F. Graus9,
  10. K. Hoang-Xuan10,
  11. M. Klein11,
  12. B. Melin12,
  13. J. Rees13,
  14. T. Siegal14,
  15. A. Smits15,
  16. R. Stupp16 and
  17. W. Wick4

Published Online: 21 SEP 2011

DOI: 10.1002/9781444346268.ch15

European Handbook of Neurological Management, Volume 2, Second Edition

European Handbook of Neurological Management, Volume 2, Second Edition

How to Cite

Soffietti, R., Baumert, B., Bello, L., von Deimling, A., Duffau, H., Frénay, M., Grisold, W., Grant, R., Graus, F., Hoang-Xuan, K., Klein, M., Melin, B., Rees, J., Siegal, T., Smits, A., Stupp, R. and Wick, W. (2011) Management of Low-Grade Gliomas, in European Handbook of Neurological Management, Volume 2, Second Edition (eds N. E. Gilhus, M. P. Barnes and M. Brainin), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346268.ch15

Editor Information

  1. 17

    Department of Clinical Medicine, University of Bergen, Norway

  2. 18

    Department of Neurology, Haukeland University Hospital, Bergen, Norway

  3. 19

    University of Newcastle, Newcastle upon Tyne, UK

  4. 20

    Hunters Moor Neurorehabilitation Ltd, Newcastle upon Tyne, UK

  5. 21

    Department of Clinical Medicine and Prevention, Austria

  6. 22

    Center for Clinical Neurosciences, Donau-Universität Krems, Austria

  7. 23

    Department of Neurology, Landesklinikum Donauregion Tulln, Tulln, Austria

Author Information

  1. 1

    University Hospital San Giovanni Battista, Turin, Italy

  2. 2

    Maastricht University Medical Centre, Maastricht, The Netherlands

  3. 3

    University of Milan, Milan, Italy

  4. 4

    University of Heidelberg, Germany

  5. 5

    Hôpital Gui de Chauliac, Montpellier, France

  6. 6

    Centre Antoine Lacassagne, Nice, France

  7. 7

    Kaiser Franz Josef Hospital, Vienna, Austria

  8. 8

    Western General Hospital, Edinburgh, United Kingdom

  9. 9

    Hospital Clinic, Barcelona, Spain

  10. 10

    Groupe Hospitalier Pitié-Salpêtrière, Paris, France

  11. 11

    VU University Medical Centre, Amsterdam, The Netherlands

  12. 12

    Umeå University, Umeå, Sweden

  13. 13

    National Hospital for Neurology and Neurosurgery, London, United Kingdom

  14. 14

    Hadassah Hebrew University Hospital, Jerusalem, Israel

  15. 15

    University Hospital, Uppsala, Sweden

  16. 16

    University Hospital and University, Lausanne, Switzerland

Publication History

  1. Published Online: 21 SEP 2011
  2. Published Print: 30 SEP 2011

ISBN Information

Print ISBN: 9781405185349

Online ISBN: 9781444346268

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Keywords:

  • management of low-grade gliomas;
  • low-grade gliomas (LGGs)-group of tumours, clinical, and molecular characteristics;
  • World Health Organization (WHO) classification-grade II astrocytomas, oligodendrogliomas and oligoastrocytomas (Class I);
  • oligodendrogliomas, cellular-perinuclear halos (‘fried egg’ or ‘honeycomb’pattern);
  • oligoastrocytomas, on detection-convincing astrocytic and oligodendroglial components;
  • seizures, common presentation-partial or generalized;
  • conventional MRI, for differential diagnosis-biopsy or resection;
  • antiepileptic treatment-no papers dealing with antiepileptic drugs (AEDs), with LGG and seizures;
  • chemotherapy (PCV or TMZ), initial treatment after surgery-in high-risk patents;
  • cognitive rehabilitation, salutary effect-on short- and long-term cognitive complaints and mental fatigue

Summary

Background: Diffuse infiltrative low-grade gliomas (LGGs) of the cerebral hemispheres in the adult are a group of tumours with distinct clinical, histological and molecular characteristics, and there are still controversies in management.

Methods: The scientific evidence collected from the literature was evaluated and graded according to EFNS guidelines, and recommendations were made.

Results and conclusions: The 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 diagnostic accuracy. Younger age, normal neurological examination, oligodendroglial histology and 1p loss are favourable prognostic factors. Prophylactic antiepileptic drugs are not useful, and there is no evidence that one drug is better than any other7. Total or near-total resection can improve seizure control and progression-free and overall survival, while reducing the risk of malignant transformation. Early postoperative radiotherapy improves progression-free but not overall survival. Low doses of radiation are as effective as high doses and are 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 tumour itself, tumour-related epilepsy, treatments and psychological distress.