Skip to main content
SpringerLink
Log in

Low-Grade Glioma

  • Chapter
  • First Online:
Book cover Current Understanding and Treatment of Gliomas

Part of the book series: Cancer Treatment and Research ((CTAR,volume 163))

Abstract

Low-grade gliomas are slower growing than their high-grade counterparts. They account for 10–20 % of all primary brain tumors. Median survival is between 4.7 and 9.8 years. The goal of treatment is to prolong overall survival while maintaining good quality of life (QOL). Recent data favors early surgical resection. EOR is associated with delayed tumor recurrence and improved survival. Additional therapy with chemotherapy or radiation is indicated in patients with high-risk features. Lower doses (between 45 and 50.4 Gy) have been shown to be as effective without adverse effects compared to higher doses. Recent trials have shown benefit in combining chemotherapy with radiation compared to radiation alone. The optimal chemotherapeutic regimen (PCV or temozolomide (TMZ)) remains unknown, although TMZ is easier to administer and better tolerated by patients. Novel molecular markers including 1p/19q chromosomal codeletion and isocitrate dehydrogenase 1 (IDH1) mutation have been correlated with treatment response and survival.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109. doi:10.1007/s00401-007-0243-4

    Article  PubMed Central  PubMed  Google Scholar 

  2. Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA, Muzikansky A, Santagata S, Ligon KL, Norden AD, Ciampa A, Bradshaw J, Levy B, Radakovic G, Ramakrishna N, Black PM, Wen PY (2009) Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res: Official J Am Assoc Cancer Res 15(1):330–337. doi:10.1158/1078-0432.CCR-08-0888

    Article  CAS  Google Scholar 

  3. Turkoglu E, Gurer B, Sanli AM, Dolgun H, Gurses L, Oral NA, Donmez T, Sekerci Z (2013) Clinical outcome of surgically treated low-grade gliomas: a retrospective analysis of a single institute. Clin Neurol Neurosurg 115(12):2508–2513. doi:10.1016/j.clineuro.2013.10.010

    Article  PubMed  Google Scholar 

  4. McCormack BM, Miller DC, Budzilovich GN, Voorhees GJ, Ransohoff J (1992) Treatment and survival of low-grade astrocytoma in adults–1977–1988. Neurosurgery 31(4):636–642 discussion 642

    Article  CAS  PubMed  Google Scholar 

  5. Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P, Afra D, Cornu P, Bolla M, Vecht C, Karim AB (2002) European organization for R, treatment of cancer brain tumor cooperative G, European organization for R, treatment of cancer radiotherapy cooperative G. Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol: Official J Am Soc Clin Oncol 20(8):2076–2084

    Article  Google Scholar 

  6. Gorlia T, Wu W, Wang M, Baumert BG, Mehta M, Buckner JC, Shaw E, Brown P, Stupp R, Galanis E, Lacombe D, van den Bent MJ (2013) New validated prognostic models and prognostic calculators in patients with low-grade gliomas diagnosed by central pathology review: a pooled analysis of EORTC/RTOG/NCCTG phase III clinical trials. Neuro-oncology 15(11):1568–1579. doi:10.1093/neuonc/not117

    Article  PubMed Central  PubMed  Google Scholar 

  7. Chang EF, Smith JS, Chang SM, Lamborn KR, Prados MD, Butowski N, Barbaro NM, Parsa AT, Berger MS, McDermott MM (2008) Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109(5):817–824. doi:10.3171/JNS/2008/109/11/0817

    Article  PubMed  Google Scholar 

  8. Hartmann C, Hentschel B, Tatagiba M, Schramm J, Schnell O, Seidel C, Stein R, Reifenberger G, Pietsch T, von Deimling A, Loeffler M, Weller M, German Glioma N (2011) Molecular markers in low-grade gliomas: predictive or prognostic? Clin Cancer Res: Official J Am Assoc Cancer Res 17(13):4588–4599. doi:10.1158/1078-0432.CCR-10-3194

    Article  CAS  Google Scholar 

  9. Baumert BG, Stupp R. European organization for R, treatment of cancer radiation oncology G, European organization for R, treatment of cancer brain tumor G (2008). Low-grade glioma: a challenge in therapeutic options: the role of radiotherapy. Ann Oncol: Official J Eur Soc Med Oncol/ESMO 19(Suppl 7):vii217–222. doi:10.1093/annonc/mdn434

  10. Kaloshi G, Benouaich-Amiel A, Diakite F, Taillibert S, Lejeune J, Laigle-Donadey F, Renard MA, Iraqi W, Idbaih A, Paris S, Capelle L, Duffau H, Cornu P, Simon JM, Mokhtari K, Polivka M, Omuro A, Carpentier A, Sanson M, Delattre JY, Hoang-Xuan K (2007) Temozolomide for low-grade gliomas: predictive impact of 1p/19q loss on response and outcome. Neurology 68(21):1831–1836. doi:10.1212/01.wnl.0000262034.26310.a2

    Article  CAS  PubMed  Google Scholar 

  11. Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, Unsgard G, Solheim O (2012) Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA, J Am Med Assoc 308(18):1881–1888. doi:10.1001/jama.2012.12807

    Article  CAS  Google Scholar 

  12. Berger MS, Deliganis AV, Dobbins J, Keles GE (1994) The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74(6):1784–1791

    Article  CAS  PubMed  Google Scholar 

  13. Recht LD, Lew R, Smith TW (1992) Suspected low-grade glioma: is deferring treatment safe? Ann Neurol 31(4):431–436. doi:10.1002/ana.410310413

    Article  CAS  PubMed  Google Scholar 

  14. Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol: Official J Am Soc Clin Oncol 26(8):1338–1345. doi:10.1200/JCO.2007.13.9337

    Article  Google Scholar 

  15. Shaw EG, Berkey B, Coons SW, Bullard D, Brachman D, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta M (2008) Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. J Neurosurg 109(5):835–841. doi:10.3171/JNS/2008/109/11/0835

    Article  PubMed  Google Scholar 

  16. Duffau H (2011) Update on surgery for diffuse low-grade gliomas: brain mapping, hodotopy and neuroplasticity. Bulletin de l’Academie nationale de medecine 195(1):37–49 (discussion 49–51)

    PubMed  Google Scholar 

  17. van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmstrom PO, Collette L, Pierart M, Mirimanoff R, Karim AB, Radiotherapy E, Brain Tumor G, the UKMRC (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366 (9490):985–990. doi:10.1016/S0140-6736(05)67070-5

  18. Karim AB, Maat B, Hatlevoll R, Menten J, Rutten EH, Thomas DG, Mascarenhas F, Horiot JC, Parvinen LM, van Reijn M, Jager JJ, Fabrini MG, van Alphen AM, Hamers HP, Gaspar L, Noordman E, Pierart M, van Glabbeke M (1996) A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat Oncol Biol Phys 36(3):549–556

    Article  CAS  PubMed  Google Scholar 

  19. Kiebert GM, Curran D, Aaronson NK, Bolla M, Menten J, Rutten EH, Nordman E, Silvestre ME, Pierart M, Karim AB (1998) Quality of life after radiation therapy of cerebral low-grade gliomas of the adult: results of a randomised phase III trial on dose response (EORTC trial 22844). EORTC Radiotherapy Co-operative Group. Eur J Cancer 34(12):1902–1909

    Article  CAS  PubMed  Google Scholar 

  20. Shaw E, Arusell R, Scheithauer B, O’Fallon J, O’Neill B, Dinapoli R, Nelson D, Earle J, Jones C, Cascino T, Nichols D, Ivnik R, Hellman R, Curran W, Abrams R (2002) Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol: Official J Am Soc Clin Oncol 20(9):2267–2276

    Article  CAS  Google Scholar 

  21. Hauswald H, Rieken S, Ecker S, Kessel KA, Herfarth K, Debus J, Combs SE (2012) First experiences in treatment of low-grade glioma grade I and II with proton therapy. Radiat Oncol 7:189. doi:10.1186/1748-717X-7-189

    Article  PubMed Central  PubMed  Google Scholar 

  22. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E (2005) Mirimanoff RO, European organisation for R, treatment of cancer brain T, radiotherapy G, national cancer institute of Canada clinical trials G.radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New Engl J Med 352(10):987–996. doi:10.1056/NEJMoa043330

    Article  CAS  PubMed  Google Scholar 

  23. Lassman AB, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldan GB, Wen PY, Ligon KL, Schiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, DeAngelis LM, Jhanwar SC, Rosenblum MK, Panageas KS (2011) International retrospective study of over 1000 adults with anaplastic oligodendroglial tumors. Neuro-oncol 13(6):649–659. doi:10.1093/neuonc/nor040

    Article  PubMed Central  PubMed  Google Scholar 

  24. Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP (2012) Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol: Official J Am Soc Clin Oncol 30(25):3065–3070. doi:10.1200/JCO.2011.35.8598

    Article  CAS  Google Scholar 

  25. RTOG 9802: A phase II study of observation in favorable low-grade glioma and a phase III study of radiation with or without PCV chemotherapy in unfavorable low-grade glioma (2014). http://wwwcancergov/newscenter/newsfromnci/2014/RTOG9802v

    Google Scholar 

  26. Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, Fink K, Souhami L, Laperriere N, Curran W, Mehta M (2013) Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol: Official J Am Soc Clin Oncol 31(3):337–343. doi:10.1200/JCO.2012.43.2674

    Article  CAS  Google Scholar 

  27. Hoang-Xuan K, Capelle L, Kujas M, Taillibert S, Duffau H, Lejeune J, Polivka M, Criniere E, Marie Y, Mokhtari K, Carpentier AF, Laigle F, Simon JM, Cornu P, Broet P, Sanson M, Delattre JY (2004) Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions. J Clin Oncol: Official J Am Soc Clin Oncol 22(15):3133–3138. doi:10.1200/JCO.2004.10.169

    Article  CAS  Google Scholar 

  28. Pace A, Vidiri A, Galie E, Carosi M, Telera S, Cianciulli AM, Canalini P, Giannarelli D, Jandolo B, Carapella CM (2003) Temozolomide chemotherapy for progressive low-grade glioma: clinical benefits and radiological response. Ann Oncol: Official J Eur Soc Med Oncol/ESMO 14(12):1722–1726

    Article  CAS  Google Scholar 

  29. Stege EM, Kros JM, de Bruin HG, Enting RH, van Heuvel I, Looijenga LH, van der Rijt CD, Smitt PA, van den Bent MJ (2005) Successful treatment of low-grade oligodendroglial tumors with a chemotherapy regimen of procarbazine, lomustine, and vincristine. Cancer 103(4):802–809. doi:10.1002/cncr.20828

    Article  PubMed  Google Scholar 

  30. Fisher BJ LJ, MacDonald DR, Lesser GJ, et al. (2013) A phase II study of a temozolomide-based chemoradiotherapy regimen for high-risk low-grade gliomas: preliminary results of RTOG 0424. J Clin Oncol 31 (suppl; abstr 2008)

    Google Scholar 

  31. Quinn JA, Reardon DA, Friedman AH, Rich JN, Sampson JH, Provenzale JM, McLendon RE, Gururangan S, Bigner DD, Herndon JE 2nd, Avgeropoulos N, Finlay J, Tourt-Uhlig S, Affronti ML, Evans B, Stafford-Fox V, Zaknoen S, Friedman HS (2003) Phase II trial of temozolomide in patients with progressive low-grade glioma. J Clin Oncol: Official J Am Soc Clin Oncol 21(4):646–651

    Article  CAS  Google Scholar 

  32. Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, Kros JM, Hainfellner JA, Mason W, Mariani L, Bromberg JE, Hau P, Mirimanoff RO, Cairncross JG, Janzer RC, Stupp R (2005) MGMT gene silencing and benefit from temozolomide in glioblastoma. New Engl J Med 352(10):997–1003. doi:10.1056/NEJMoa043331

    Article  CAS  PubMed  Google Scholar 

  33. Everhard S, Kaloshi G, Criniere E, Benouaich-Amiel A, Lejeune J, Marie Y, Sanson M, Kujas M, Mokhtari K, Hoang-Xuan K, Delattre JY, Thillet J (2006) MGMT methylation: a marker of response to temozolomide in low-grade gliomas. Ann Neurol 60(6):740–743. doi:10.1002/ana.21044

    Article  CAS  PubMed  Google Scholar 

  34. Viaccoz A, Lekoubou A, Ducray F (2012) Chemotherapy in low-grade gliomas. Curr Opin Oncol 24(6):694–701. doi:10.1097/CCO.0b013e328357f503

    Article  CAS  PubMed  Google Scholar 

  35. Gilbert MR, Wang M, Aldape KD, Stupp R, Hegi ME, Jaeckle KA, Armstrong TS, Wefel JS, Won M, Blumenthal DT, Mahajan A, Schultz CJ, Erridge S, Baumert B, Hopkins KI, Tzuk-Shina T, Brown PD, Chakravarti A, Curran WJ Jr, Mehta MP (2013) Dose-dense temozolomide for newly diagnosed glioblastoma: a randomized phase III clinical trial. J Clin Oncol: Official J Am Soc Clin Oncol 31(32):4085–4091. doi:10.1200/JCO.2013.49.6968

    Article  CAS  Google Scholar 

  36. Baumert B SR Radiation Therapy or temozolomide in treating patients with gliomas (NCT00182819)

    Google Scholar 

  37. KA J Radiation therapy with concomitant and adjuvant temozolomide or radiation therapy with adjuvant PCV or temozolomide alone in treating patients with anaplastic glioma (NCT00887146)

    Google Scholar 

  38. Chang S PM Phase II trial of RAD001 in patients with recurrent low grade glioma (NCT00823459)

    Google Scholar 

  39. Prins R Vaccine for patients with newly diagnosed or recurrent low-grade glioma (NCT01635283)

    Google Scholar 

  40. Lustig R Proton beam radiation therapy in treating patients with low grade gliomas (NCT01024907)

    Google Scholar 

  41. Ongoing studies Ref: http://www.clinicaltrials.gov/ct2/results?term=low+grade+glioma&pg=3

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Northwestern University, 710 North Lake Shore Drive, Abbott Hall, 11th Floor, Chicago, IL, 60611, USA

    Priya Kumthekar, Jeffrey Raizer & Simran Singh

Authors
  1. Priya Kumthekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Raizer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simran Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Priya Kumthekar .

Editor information

Editors and Affiliations

  1. Department of Neurology, Northwestern University, Chicago, Illinois, USA

    Jeffrey Raizer

  2. Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA

    Andrew Parsa

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Kumthekar, P., Raizer, J., Singh, S. (2015). Low-Grade Glioma. In: Raizer, J., Parsa, A. (eds) Current Understanding and Treatment of Gliomas. Cancer Treatment and Research, vol 163. Springer, Cham. https://doi.org/10.1007/978-3-319-12048-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-12048-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-12047-8

  • Online ISBN: 978-3-319-12048-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation