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Low-Grade
Gliomas in Adults
Edward
J Dropcho, MD
Department
of Neurology, CL 291, Indiana University Medical Center and the
Indianapolis Veterans Affairs Medical Center, Indianapolis, IN, 46202,
USA
Adult
patients with a magnetic resonance scan suggestive of a supratentorial
low-grade glioma should generally undergo at least a stereotactic
biopsy to confirm the diagnosis and rule out an anaplastic glioma or a
non-neoplastic lesion.
Early
tumor treatment should be given to patients with newly diagnosed
low-grade gliomas who are over age 50 years, those who have headaches
or neurologic deficits other than seizures, or those whose
-neuroimaging studies show tumor growth or mass effect.
For
younger patients presenting with seizures and no other neurologic
symptoms, it is reasonable to defer therapy until there is clinical or
radiographic tumor progression.
When
it is judged that intervention is necessary, patients should undergo
the maximal surgical tumor resection, which preserves or improves
neurologic function.
For
younger (50 years) astrocytoma patients with a good tumor resection,
radiation may be deferred until tumor progression.
Early
radiation should be given to astrocytoma patients who are older than
50 years of age at diagnosis (regardless of the type of surgery) or to
younger patients who are judged to require early intervention but who
are not candidates for aggressive surgical resection.
The
radiation dose for low-grade glioma should be 4500 to 5000 cGy,
preferably with three-dimensional conformal ports.
The
same guidelines for management apply to patients with low-grade
oligodendroglioma or oligoastrocytoma, except that chemotherapy is a
reasonable alternative to radiation when it is judged that treatment
other than surgical resection is required.
© 2004 BioMed
Central Ltd
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