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Low-grade gliomas

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Low-grade gliomas are uncommon primary brain tumors classified as histologic grades I or II in the World Health Organization (WHO) classification. The most common variants are pilocytic and low-grade astrocytomas, oligodendrogliomas, and mixed oligo-astrocytomas located in the cerebral hemispheres. Prognostic factors that predict progressionfree and overall survival include young age, pilocytic histology, good Karnofsky performance status, gross total resection, lack of enhancement on imaging, and small preoperative tumor volumes. Edema and vasogenic effects are typically managed with corticosteroids. Dexamethasone is given at an initial dosage of 4 mg given four times daily. Anticonvulsants are given prophylactically after resection and for patients who present with seizures. The rationale for open craniotomy depends on the need for immediate palliation of symptoms by reduction of intracranial pressure or focal mass effect, and/or improved oncologic control. Gross total resection of tumor is generally defined as the absence of residual enhancement on contrast-enhanced postoperative MRI scan. Most retrospective studies suggest that patients who have undergone a gross total resection of tumor have improved survival. Depending upon the proximity of the tumor to eloquent brain, gross total resection may or may not be possible. In these cases a stereotactic biopsy is required to provide the histologic diagnosis. Adjuvant radiotherapy is recommended for patients with incompletely resected grade II tumors or for patients older than age 40 regardless of extent of resection. It may be considered for any pilocytic astrocytoma from which a biopsy has been performed. Phase III randomized prospective trials have shown statistically significantly improved progression-free survival at 5 years with the addition of radiotherapy, though overall survival does not appear different. Based on prospective randomized phase III trials, 50.4 Gy to 54 Gy of conventionally fractionated radiotherapy appears to be a safe and effective regimen with minimal neurotoxicity; 45 Gy may be adequate for biopsied pilocytic astrocytomas. Currently, RTOG trial 98-02 is investigating the efficacy of postradiation PCV chemotherapy (procarbazine, CCNU, and vincristine) in the treatment of newly diagnosed unfavorable low-grade gliomas. Other areas of investigation include Temozolomide chemotherapy and the association of 1p and 19q chromosomal deletions with prolonged survival in oligodendrogliomas and sensitivity to PCV chemotherapy. Radiosurgery and/or experimental chemotherapy may provide some measure of local control in the recurrent disease setting.

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References and Recommended Reading

  1. Statistical Report: primary brain tumors in the United States, 1992–1997. Central Brain Tumor Registry of the United States 2000, Current epidemiological data.

  2. Woolam G: Cancer Statistics, 2000: a benchmark for the new century. CA Cancer J Clin 2000, 50:7–33. Current epidemiological data.

    Article  Google Scholar 

  3. Davis FG, Kupelian V, Freels S, et al.: Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro-Oncol 2001, 3:152–158.

    PubMed  CAS  Google Scholar 

  4. World Health Organization. Classification of Tumours, Pathology and Genetics of Tumours of the Nervous System. Edited by Kleihues P, Cavence WK. Lyon, France: IARC Press; 2000. This is the international standard of pathologic classification of primary brain tumors, recently updated.

    Google Scholar 

  5. Jukich PJ, McCarthy BJ, Surawicz TS, et al.: Trend in incidence of primary brain tumors in the United States, 1985-1994. Neuro-Oncol 2001, 3:141–151.

    Article  PubMed  CAS  Google Scholar 

  6. Brain Tumors: An Encyclopedic Approach, edn. 2. Edited by Kaye AH, Laws ER. London, UK: Churchill Livingstone; 2001.

    Google Scholar 

  7. Cancer of the Nervous System, edn. 1. Edited by Black PM, Loeffler JS. Boston: Blackwell Science; 1997.

    Google Scholar 

  8. The Gliomas. Edited by Berger M, Wilson C. Philadelphia: WB Saunders; 1999.

    Google Scholar 

  9. The Practical Management of Low-Grade Primary Brain Tumors. Edited by Rock JP, Rosenblum M, Shaw E, Cairncross J. Philadelphia: Lippincott Williams & Wilkins; 1999.

    Google Scholar 

  10. Shaw E: Low Grade Gliomas. Sem Radiat Oncol 2001, 2:93–180. Comprehensive recent overview of the management of low-grade gliomas.

    Article  Google Scholar 

  11. Laws ER Jr, Taylor WF, Clifton MB, et al.: Neurosurgical management of low-grade astrocytomas of the cerebral hemispheres. J Neurosurg 1984, 61:665–673.

    PubMed  Google Scholar 

  12. Shaw E, Arusell R, Scheithauer B, et al.: A prospective randomized trial of low-versus high-dose radiation therapy in adults with supratentorial low-grade gliomas: initial report of a NCCTG-RTOG-ECOG study abstract]. Proc ASCO 1998, 17:401a. Phase III trial that examines the question of radiotherapy dose.

    Google Scholar 

  13. Lote K, Egeland T, Hagar B, et al.: Survival, prognostic factors, and therapeutic efficacy in low-grade gliomas: a retrospective study in 379 patients. J Clin Oncol 1997, 15:3129–3140.

    PubMed  CAS  Google Scholar 

  14. Shaw EG, Daumas-Duport C, Scheithauer BW, et al.: Radiation therapy in the management of low-grade supratentorial astrocytomas. J Neurosurg 1989, 70:853–861.

    PubMed  CAS  Google Scholar 

  15. Berger M, Deliganis A, Dobbins J, et al.: The effect of extent of resection on recurrence in patients with low-grade cerebral hemisphere gliomas. Cancer 1994, 74:1784–1791.

    Article  PubMed  CAS  Google Scholar 

  16. Bauman G, Lote K, Larso D, et al.: Pretreatment factors predict overall survival for patients with low-grade gliomas:a recursive partitioning analysis. Int J Radiat Oncol Biol Phys 1999, 45:923–9239. Recent recursive partitioning analysis of prognostic factors.

    Article  PubMed  CAS  Google Scholar 

  17. Brown J, Byers T, Thompson K, et al.: Nutrition during and after cancer treatment: a guide for informed choices by cancer survivors. CA Cancer J Clin 2001, 51:153–187.

    PubMed  CAS  Google Scholar 

  18. National Radiological Protection Board: Electromagnetic fields and the risk of cancer. National Radiological Protection Board, Report of an advisory group on non-ionising radiation. Doc NRBP 1992, 3:1–138.

    Google Scholar 

  19. Giles GG, Gonzales MF: Epidemiology of brain tumors and factors in prognosis. In Brain Tumors: An Encyclopedic Approach, edn. 2. Edited by Kaye AH, Laws ER. London, UK: Churchill Livingstone, 2001:189–215.

    Google Scholar 

  20. Ricci PE, Dungan DH: Imaging of low- and intermediate-grade gliomas. Sem Radiat Oncol 2001, 11:103–112. Useful summary of diagnostic imaging criteria.

    Article  CAS  Google Scholar 

  21. Leiguarda R, Sierra J, Pardal C, et al.: Effect of large doses of methylprednisolone on supratentorial intracranial tumors. A clinical and CAT scan evaluation. Eur Neurol 1985, 24:23–32.

    PubMed  CAS  Google Scholar 

  22. Yamada K, Ushio Y, Hayakawa T: Effects of steroid on the blood brain barrier. In Implications of the Blood-brain Barrier and its Manipulation. Edited by Neuwelt EA. New York: Plenum Press, 1989;1:53–76.

    Google Scholar 

  23. Thapar K, Taylor MD, Laws ER, et al.: Brain edema, increased intracranial pressure, and vascular effects of human brain tumors. In Brain Tumors: An Encyclopedic Approach edn. 2. Edited by Kaye AH, Laws ER. London, UK: Churchill Livingstone, 2001:189–215.

    Google Scholar 

  24. Tatter SB: Neurosurgical management of low- and intermediate-grade gliomas. Semin Radiat Oncol 2001, 11:113–123. Comprehensive overview of surgical management of low-grade gliomas.

    Article  PubMed  CAS  Google Scholar 

  25. Bilsky M, Posner JB: Intensive and postoperative care of intracranial tumors. In Neurological and Neurosurgical Intensive Care, edn. 3. Edited by Ropper AH. New York: Raven Press, 1993:309–329.

    Google Scholar 

  26. Del Maestro RF, Megyesi JF, Farrell CL: Mechanisms of tumor-associated edema: a review. Can J Neurol Sci 1990, 17:177–183.

    PubMed  Google Scholar 

  27. Grossman SA, Suleman S, Eller S, et al.: Novel COX-2 inhibitor is equal to dexamethasone in prolonging survival in rats with 9L gliomas. Proc ASCO 2001, 20:53a.

    Google Scholar 

  28. Watson GA, Kadota RP, Wisoff JH: Multidisciplinary management of pediatric low-grade gliomas. Semin Radiat Oncol 2000, 11:152–162.

    Article  Google Scholar 

  29. Berger M, Rostomily R: Low-grade gliomas: functional mapping resection strategies, extent of resection, and outcome. J Neurooncol 1997, 34:85–101.

    Article  PubMed  CAS  Google Scholar 

  30. Berger M, Wilson C: Extent of resection and outcome for cerebral hemispheric gliomas. In The Gliomas. Edited by Berger M, Wilson C. London, UK: WB Saunders, 1999:660–679.

    Google Scholar 

  31. Lunsford LD, Somaza S, Kondziolka D, Flickinger JC: Survival after stereotactic biopsy and irradiation of cerebral nonanaplastic, nonpilocytic astrocytoma. J Neurosurg 1995, 82:523–529.

    PubMed  CAS  Google Scholar 

  32. Wallner KE, Gonzales M, Sheline GE. Treatment of oligodendrogliomas with or without postoperative irradiation. J Neurosurg 1988, 68:684–688.

    PubMed  CAS  Google Scholar 

  33. Karim AB, Cornu N, Bleheem D, et al.: Immediate postoperative radiotherapy in low-grade gliomas improves progression free survival, but not overall survival: preliminary results of an EORTC/MRC randomized phase III study. Proc ASCO 1998, 17:400a. Phase III trial that examines the need for adjuvant radiotherapy.

    Google Scholar 

  34. Bolla M. EORTC trials: a bridge between two millennia abstract]. Radiother Oncol 2001, 58:S58.

    Google Scholar 

  35. Lindegaard KF, Mork SJ, Eide GE, et al.: Statistical analysis of clinicopathological features, radiotherapy, and survival in 170 cases of oligodendroglioma. J Neurosurg 1987, 67:224–230.

    PubMed  CAS  Google Scholar 

  36. Karim A, Maat B, Hatlevoll R, et al.: A randomized trial of dose-response in radiation therapy of low-grade gliomas: EORTC Study 22844. Int J Radiat Oncol Biol Phys 1996, 36:549–556. This phase III trial examines the question of radiotherapy dose.

    Article  PubMed  CAS  Google Scholar 

  37. North CA, North RB, Epstein JA, et al.: Low-grade cerebral astrocytomas: survival and quality of life after radiation therapy. Cancer 1990, 66:6–14.

    Article  PubMed  CAS  Google Scholar 

  38. Marks JE, Wong I: The risk of cerebral radionecrosis in relation to dose, time and fractionation: a follow-up study. Prog Exp Tumor Res 1985, 29:210–218.

    PubMed  CAS  Google Scholar 

  39. Hammack J, Shaw E, Ivnik R, et al.: Neurocognitive function in patients receiving radiation therapy for supratentorial low-grade gliomas: a North Central Cancer Treatment Group prospective study abstract]. Proc ASCO 1995, 14:151. Examines a subgroup of patients from a phase II randomized prospective trial for cognitive deficits from radiotherapy.

    Google Scholar 

  40. Brown PD, Buckner JC, Brown CA, et al.: The effects of radiation on cognitive function in patients with lowgrade gliomas. Proc ASCO 2001, 20:58a. Examines a subgroup of patients from a phase II randomized prospective trial for cognitive deficits from radiotherapy.

    Google Scholar 

  41. Eyre HJ, Eltringham JR, Crowley J, et al.: A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: Southwest Oncology Group Study. J Neurosurg 1993, 78:909–914. Phase III trial that demonstrates the lack of efficacy of single-agent chemotherapy.

    Article  PubMed  CAS  Google Scholar 

  42. Van den Bent MJ, Kros JM, Heimans JJ, et al.: Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Neurol 1998, 51:1140–1145.

    Google Scholar 

  43. Buckner JC, Smith JS, Nelson DF, et al.: Phase II trial of procarbazine, CCNU, and vincristine (PCV) as initial therapy in patients with low-grade oligodendroglioma or oligoastrocytoma: efficacy results and associations with chromosome 1p and 19q loss abstract]. Proc ASCO 1999, 18:140.

    Google Scholar 

  44. Thoron L, Colinskas C, McDevitt K, et al.: Adjuvant I-PCV chemotherapy for treatment of low-grade oligodendroglioma. Proc Am Soc Clin Oncol 1997, 16:410.

    Google Scholar 

  45. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 1951, 102:316–319. Seminal paper from the inventor of the Elekta Gamma Knife and modern radiosurgery.

    PubMed  CAS  Google Scholar 

  46. Friedman WA, Bova FJ: The University of Florida radiosurgery system. Surg Neurol 1989, 32:334–342.

    Article  PubMed  CAS  Google Scholar 

  47. Shaw E, Scott C, Souhami L, et al.: Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 2000, 47:291–298. Landmark radiosurgery dose-escalation trial.

    Article  PubMed  CAS  Google Scholar 

  48. van Rijn J, Heimans JJ, van den Berg J, et al.: Survival of human glioma cells treated with various combination of temozolomide and x-rays. Int J Radiat Oncol Biol Phys 2000, 47:779–784.

    Article  PubMed  Google Scholar 

  49. van den Bent MJ, Chinot O, Boogerd W, et al.: EORTC study 26972: second line temozolomide chemotherapy in recurrent oligodendroglial tumors after PCV chemotherapy. Proc ASCO 2001, 20:52a.

    Google Scholar 

  50. Friedman AH, Cokgor I, Edward S, et al.: Phase II treatment of anaplastic oligodendroglioma and low-grade gliomas with temozolomide. abstract]. Proc ASCO 2000, 19:169.

    Google Scholar 

  51. Viviers L, Brada M, Hines F, et al.: A phase II trial of primary chemotherapy with temozolomide in patients with low-grade cerebral gliomas abstract]. Proc ASCO 2000, 19:167.

    Google Scholar 

  52. Viviers L, Murphy P, Britton J, et al.: A phase II trial of primary chemotherapy with temozolomide in patients with low-grade cerebral gliomas. Radiother Oncol 2001, 58:S58.

    Google Scholar 

  53. Smith JS, Alderet B, Minn T, et al.: Localization of common deletion regions on 1p and 19q in human gliomas and their association with histological subtype. Oncogene 1999, 18:4144–4152.

    Article  PubMed  CAS  Google Scholar 

  54. Reifenberger J, Reifenberger G, Liu L, et al.: Molecular genetic analysis of oligodendroglial tumors shows preferential allelic deletions on 19q and 1p. Am J Pathol 1994, 145:1175–1190.

    PubMed  CAS  Google Scholar 

  55. Cairncross JG, Ueki K, Zlatescu MC, et al.: Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendroglioma. J Natl Cancer Inst 1998, 90:1473–1479.

    Article  PubMed  CAS  Google Scholar 

  56. Smith JS, Perry A, Borell TJ, et al.: Alterations of chromosome arms 1p and 19q as predictors of survival in oligodendrogliomas, astrocytomas, and mixed oligoastrocytomas. J Clin Oncol 2000, 18:636–645.

    PubMed  CAS  Google Scholar 

  57. Bigner SH, Matthews MR, Rasheed BK, et al.: Molecular genetic aspects of oligodendrogliomas including analysis of comparative genomic hybridization. Am J Pathol 1999, 155:375–386.

    PubMed  CAS  Google Scholar 

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  1. Department of Radiation Oncology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, 27157-1030, Winston-Salem, NC, USA

    Volker W. Stieber MD

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Stieber, V.W. Low-grade gliomas. Curr. Treat. Options in Oncol. 2, 495–506 (2001). https://doi.org/10.1007/s11864-001-0071-z

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