Guidelines on management of low‐grade gliomas: report of an EFNS–EANO* Task Force

European Journal of Neurology - Tập 17 Số 9 - Trang 1124-1133 - 2010
Riccardo Soffietti1, Brigitta G. Baumert2, Lorenzo Bello3, Andreas von Deimling4, Hugues Duffau5, M. Frénay6, Wolfgang Grisold7, Robin Grant8, Francesc Graus9, Khê Hoang-Xuân10, Martin Klein11, Beatrice Melin12, Jeremy Rees13, Tali Siegal14, Anja Smits15, Roger Stupp16, Wolfgang Wick17
1Azienda Sanitaria Ospedaliera Molinette San Giovanni Battista Di Torino
2Maastricht Univ.
3Department of Neurological Sciences, Neurosurgery, University, Milan, Italy
4Department of Neuropathology, University, Heidelberg, Germany
5Department of Neurosurgery, Hôspital Guide Chauliac, Montpellier, France
6Centre Antoine Lacassagne
7Kaiser Franz Josef Hospital
8Centre for Neuro-Oncology, Western General Hospital, Edinburgh, UK
9Service of Neurology, Hospital Clinic, Barcelona, Spain
10Service de Neurologie, Groupe Hospitalier Pitié‐Salpêtrière, Paris, France
11Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
12Umea University
13University College London
14Hadassah University Medical Centre
15 Uppsala University
16Department of Neurosurgery, Medical Oncology, University Hospital, Lausanne, Switzerland
17Department of Neurooncology, University, Heidelberg, Germany

Tóm tắt

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.

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European Journal of Neurology

Tập 17 Số 9

1124-1133

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