Newer strategies for the management of low-grade gliomas

Low-grade gliomas are infiltrative primary brain tumors that most commonly occur in young adults. They are relatively slow growing compared with high-grade gliomas. The World Health Organization classification system was updated in 2016 to define low-grade gliomas using molecular markers in addition to histology. IDH mutation is an independent marker associated with better outcomes. Management is individualized based on tumor histology, molecular characterization, and patient risk factors. Given the longer course and natural history of low-grade gliomas, the goals of treatment should be to prolong overall survival and minimize neurocognitive decline. Early maximum safe resection is the first line of treatment. While low-risk patients may be followed with observation after surgery, patients with high-risk factors (subtotal resection, age > 40 years, IDH wild-type tumors) should be treated with radiation and chemotherapy. Improved understanding of the molecular characteristics of low-grade gliomas will further guide risk stratification and allow the identification of treatment approaches that are more effective and less toxic.