The Changing Management of Low-Grade Astrocytomas and Oligodendrogliomas

Low-grade gliomas are uncommon primary brain tumors that preferentially affect young to middle-aged adults. Although they are indolent tumors, low-grade gliomas cause considerable and progressive morbidity and are ultimately fatal. Surgery and radiotherapy are the primary therapeutic options for patients with these diseases. Chemotherapy is playing a larger role in the management of patients with low-grade gliomas. Patients with oligodendrogliomas or other low-grade gliomas that harbor a distinct genetic derangement characterized by allelic loss of chromosomes 1p and 19q appear to have a superior prognosis that is due in part to a more predictable and durable response to treatment, including chemotherapy. For this subset of patients with low-grade gliomas, treatment with initial chemotherapy and deferred radiotherapy is an increasingly attractive therapeutic approach.