Management for Different Glioma Subtypes: Are All Low-Grade Gliomas Created Equal?

Am Soc Clin Oncol Educ Book. 2019 Jan:39:133-145. doi: 10.1200/EDBK_238353. Epub 2019 May 17.

Abstract

Following the identification of key molecular alterations that provided superior prognostication and led to the updated 2016 World Health Organization (WHO) Central Nervous System (CNS) Tumor Classification, the understanding of glioma behavior has rapidly evolved. Mutations in isocitrate dehydrogenase (IDH) 1 and 2 are present in the majority of adult grade 2 and 3 gliomas, and when used in conjunction with 1p/19q codeletion for classification, the prognostic distinction between grade 2 versus grade 3 is diminished. As such, the previously often used term of "low-grade glioma," which referred to grade 2 gliomas, has now been replaced by the phrase "lower-grade glioma" to encompass both grade 2 and 3 tumors. Additional molecular characterization is ongoing to even further classify this heterogeneous group of tumors. With such a colossal shift in the understanding of lower-grade gliomas, management of disease is being redefined in the setting of emerging molecular-genetic biomarkers. In this article, we review recent progress and future directions regarding the surgical, radiotherapeutic, chemotherapeutic, and long-term management of adult lower-grade gliomas.

Publication types

  • Review

MeSH terms

  • Biomarkers, Tumor
  • Combined Modality Therapy / adverse effects
  • Combined Modality Therapy / methods
  • Disease Management
  • Glioma / complications
  • Glioma / diagnosis*
  • Glioma / etiology
  • Glioma / therapy*
  • Humans
  • Neoplasm Grading
  • Neoplasm Staging
  • Nervous System Diseases / etiology
  • Nervous System Diseases / therapy

Substances

  • Biomarkers, Tumor