EFNS: European Federation of Neurological Societies.
EFNS GUIDELINES/CME ARTICLE‡
Guidelines on management of low-grade gliomas: report of an EFNS–EANO Task Force*
Article first published online: 16 AUG 2010
© 2010 The Author(s). European Journal of Neurology © 2010 EFNS
European Journal of Neurology
Volume 17, Issue 9, pages 1124–1133, September 2010
How to Cite
Soffietti, R., Baumert, B.G., 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. (2010), Guidelines on management of low-grade gliomas: report of an EFNS–EANO Task Force. European Journal of Neurology, 17: 1124–1133. doi: 10.1111/j.1468-1331.2010.03151.x
EANO: European Association for Neuro-Oncology.
This is a Continuing Medical Education article, and can be found with corresponding questions on the Internet at http://www.efns.org/EFNS Continuing-Medical-Education-online.301.0.html. Certificates for correctly answering the questions will be issued by the EFNS.
- Issue published online: 16 AUG 2010
- Article first published online: 16 AUG 2010
- Received 6 November 2009 Accepted 8 June 2010
- low-grade gliomas;
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.
Results and 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.