ACTR-55. ADVANCES IN MANAGEMENT OF LOW-GRADE GLIOMAS

Abstract

BACKGROUND: Low-grade gliomas (LGGs) are common brain tumors that arise from various glial cells of the brain. The complex and variable backgrounds of LGGs cause difficulties in assigning therapies. In this report, we compile findings relating to LGG genetics and treatment options in order to create a coherent summary for referential use. METHODS: We compiled 70 articles from the past ten years that cover a broad range of topics pertaining to LGGs, including molecular, genetic, epigenetic, morphological, and other diagnostic factors, as well as prognosis and treatment options. RESULTS: Molecular basis and histology of the tumor must be addressed for proper treatment. The 1p/19q co-deletion indicator has been considered the gold standard of glioma diagnosis and prognosis, but oft-sighted mutations in the IDH1 and IDH2 genes have given rise to three subgroups of 1p/19q co-deleted tumors, each associated with specific patterns of glial cells. Other molecular markers and microRNA expression patterns have been studied for possible diagnostic/prognostic methods. Microsurgical resection is the singular treatment with highest overall survival (OS) and quality of life (QOL). Total gross resection is optimal, with patients having a 5-year OS of 100% with 90% tumor resection. Low doses of radiation are as effective as high doses and are better tolerated. Additionally, radiation followed by PCV chemotherapy caused major increases in OS. Temozolomide also offers a favorable toxicity profile and QOL; additionally, seizure reduction is an early and consistent prognostic marker for survival after treatment with Temozolomide. CONCLUSIONS: The “wait and see” approach for treatment is no longer the standard for LGGs. Immediate treatment after diagnosis is recommended. Gross total resection (if achievable) is the most favorable treatment, with the highest OS and QOL. The use of chemotherapy and radiotherapy is recommended. Histological background and genetic markers are vital for determining a treatment plan.