Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-27T04:55:58.776Z Has data issue: false hasContentIssue false
  • English
  • Français

PROGRESS IN CLINICAL NEUROSCIENCES: Advances in the Management of Low-Grade Gliomas

Published online by Cambridge University Press:  02 December 2014

Warren P. Mason
Warren P. Mason*
Affiliation:
Department of Medical Oncology & Hematology, Princess Margaret, Hospital, Toronto, Ontario,Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The management of low-grade gliomas represents one of the most challenging and controversial areas in neuro-oncology. Many aspects of the treatment of low-grade gliomas are debated, including the optimal timing of surgery and radiotherapy, the benefit of extensive surgery, and the impact of these variables on the natural history of these indolent and generally incurable tumours. The recently published results of several large multicentre trials addressing the timing and dose of radiotherapy have provided solid evidence for delayed and reduced dose irradiation. These studies have also confirmed prognostic variables that can be used to guide management of individual patients. Among these variables is the observation that tumours with oligodendroglial features have a better natural history and response profile. The recognition that as many as two thirds of low-grade gliomas have oligodendroglial features, advances in molecular diagnostics making accurate pathologic diagnosis of oligodendroglial tumours possible, and the established chemosensitivity of malignant oligodendrogliomas, have raised new issues surrounding the potential value of chemotherapy for low-grade gliomas. This review will be restricted to low-grade diffuse astrocytomas, oligodendrogliomas, and low-grade mixed oligoastrocytomas in adults, and provide evidence-based guidelines for the management of these tumours, including the emerging role of chemotherapy as initial treatment.

Résumé:

RÉSUMÉ:

Le traitement des gliomes à faible malignitÉ demeure un des domaines les plus controversÉs en neuro-oncologie. Plusieurs aspects de leur traitement, soit le meilleur moment pour la chirurgie et la ratiothÉrapie, les bÉnÉfices d’une chirurgie extensive et l’impact de ces variables sur l’histoire naturelle de ces tumeurs indolentes et gÉnÉralement incurables, font l’objet de controverses. Les rÉsultats de plusieurs grandes Études multicentriques publiÉes rÉcemment sur le moment de l’administration et la dose de radiothÉrapie ont fourni des donnÉes solides favorisant une irradiation tardive, à faible dose. Ces Études ont Également confirmÉ que certaines variables sont utiles pour Établir un pronostic et peuvent être utilisÉes pour guider la prise en charge individuelle des patients. Il est bien Établi que les tumeurs qui ont des caractÉristiques oligodendrogliales ont une histoire naturelle plus favorable et une meilleure rÉponse au traitement. On sait maintenant que les deux-tiers des gliomes à faible malignitÉ ont des caractÉristiques oligodendrogliales. Les progrès effectuÉs dans le diagnostic molÉculaire, qui rendent possible un diagnostic anatomopathologique prÉcis dans les cas de tumeurs oligodendrogliales, et la chimiosensibilitÉ des oligodendrogliomes malins ont suscitÉ des discussions sur la valeur potentielle de la chimiothÉrapie dans les gliomes à faible malignitÉ Cette revue se limite aux astrocytomes diffus à faible malignitÉ, aux oligodendrogliomes et aux oligoastrocytomes mixtes à faible malignitÉ chez les adultes et fournit des lignes directrices basÉes sur des donnÉes probantes pour le traitement de ces tumeurs, particulièrement quant au rôle Émergeant de la chimiothÉrapie comme traitement initial.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 18 - 26
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1. Shaw, E, Arusell, R, Scheithauer, B, et al. Prospective randomizedtrial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Group/Radiation therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 2002; 20: 2267–2276.CrossRefGoogle Scholar
2. Buatti, J, Meeks, S, Ryken, T, Carlisle, T. Low-grade gliomas:answering one question in a myriad of new questions. J Clin Oncol 2002; 20: 2223–2224.CrossRefGoogle Scholar
3. Cairncross, JG, Laperriere, NJ. Low-grade gliomas: to treat or not totreat? Arch Neurol 1990; 47: 1139–1140.Google Scholar
4. Hart, M, Petito, C, Earle, K. Mixed gliomas. Cancer 1974; 1: 134–140.3.0.CO;2-I>CrossRefGoogle Scholar
5. Leibel, S, Sheline, G, Wara, W, Boldrey, E, Neilson, S. The role ofradiation therapy in the treatment of astrocytomas. Cancer 1975; 35: 1551–1557.Google Scholar
6. Shaw, E, Daumas-Duport, C, Scheithauer, B, et al. Radiation therapyin the management of low-grade supratentorial astrocytomas. J Neurosurg 1989; 70: 853–861.Google Scholar
7. Shaw, E, Scheithauer, B, O’Fallon J, Davis D. Mixedoligoastrocytomas: a survival and prognostic factor analysis. Neurosurgery 1994; 34: 577–582.Google Scholar
8. Philippon, J, Clemenceau, S, Fauchon, F, Foncin, J. Supratentoriallow-grade astrocytomas in adults. Neurosurgery 1993; 32: 554–559.CrossRefGoogle ScholarPubMed
9. McCormack, B, Miller, D, Budzilovich, G, Voorhees, G, Ransohoff, J. Treatment and survival of low-grade astrocytoma in adults-1977-1988. Neurosurgery 1992; 31: 636–642.Google ScholarPubMed
10. Laws, E, Taylor, W, Clifton, M, Okazaki, H. Neurosurgicalmanagement of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 1984; 61: 665–673.CrossRefGoogle ScholarPubMed
11. Burger, P, Scheithauer, B. Tumours of the Central Nervous System. Washington, DC. Armed Forces Institute of Pathology, 1994.Google Scholar
12. Daumas-Duport, C, Scheithauer, B, O’Fallon, J, Kelly, P. Grading ofastrocytomas. A simple and reproducible method. Cancer 1988; 62: 2152–2165.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
13. Russel, D, Rubinstein, L. Pathology of tumours of the central nervoussystem. Baltimore: Williams and Wilkins, 1989.Google Scholar
14. Whitton, A, Bloom, H. Low grade glioma of the cerebral hemispheresin adults: a retrospective analysis of 88 cases. Int J Radiat Oncol Biol Phys 1990; 18: 783–786.Google Scholar
15. Kraus, J, Koopmann, J, Kaskel, P, et al. Shared allelic losses onchromosomes 1p and 19q suggest a common origin of oligodendroglioma and oligoastrocytoma. J Neuropathol ExpNeurol 1995; 54: 91–95.Google Scholar
16. Louis, D. Amolecular genetic model of astrocytoma histopathology. Brain Pathol 1997; 7: 755–764.CrossRefGoogle Scholar
17. Louis, DN. The p53 gene and protein in human brain tumours. J Neuropathol Exp Neurol 1994; 53: 11–21.CrossRefGoogle Scholar
18. Louis, D, von Deimling, A, Chung, R, et al. Comparative study of p53gene and protein alterations in human astrocytomas. J Neuropathol Exp Neurol 1993; 52: 31–38.Google Scholar
19. Kitange, G, Templeton, K, Jenkins, R. Recent advances in themolecular genetics of primary gliomas. Curr Opin Oncol 2003; 15: 197–203.Google Scholar
20. Cairncross, JG, Ueki, K, Zlatescu, MC, et al. Specific geneticpredictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 1998; 90: 1473–1479.Google Scholar
21. Reifenberger, J, Reifenberger, G, Liu, L, et al. Molecular geneticanalysis of oligodendroglial tumours shows preferential allelicdeletions on 19q and 1p. Am J Pathol 1994; 145: 1175–1190.Google Scholar
22. von Deimling, A, Louis, D, von Ammon, K, et al. Evidence for atumour suppressor gene on chromosome 19q with human astrocytomas, oligodendrogliomas and mixed gliomas. Cancer Res 1992; 52: 4277–4279.Google Scholar
23. Buckner, J, Gesme, D Jr., O’Fallon, JR, et al. Phase II trial ofprocarbazine, lomustine, and vincristine as initial therapy for patients with low-grade oligodendroglioma or oligoastrocytoma: efficacy and associations with chromosomal abnormalities. J Clin Oncol 2003; 21: 251–255.CrossRefGoogle ScholarPubMed
24. Vertosick, F, Selker, R, Arena, V. Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography. Neurosurgery 1991; 28: 496–501.CrossRefGoogle ScholarPubMed
25. Soffietti, R, Chio, A, Giordana, M, Vasario, E. Prognostic factors inwell - differentiated cerebral astrocytoma in the adult. Neurosurgery 1989; 24: 686–692.Google Scholar
26. Leighton, C, Fisher, B, Bauman, G, et al. Supratentorial low-gradeglioma in adults: an analysis of prognostic factors and timing ofradiation. J Clin Oncol 1997; 15: 1294–1301.CrossRefGoogle Scholar
27. Lee, Y-Y, Tassel, P, Bruner, J, Moser, R, Share, J. Juvenile pilocyticastrocytomas: CT and MR characteristics. Am J Radiol 1989; 152: 1263–1270.Google ScholarPubMed
28. Brotchi, J, Baleriaux, D, Delecluse, F. MRI and surgical treatment oflow grade gliomas. IMBO/JIOC 1986; 211–215.Google Scholar
29. Kelly, P, Daumas-Duport, C, Scheithauer, B, Kall, B, Kispert, D. Stereotactic histologic correlations of computed tomography- and magnetic resonance imaging-defined abnormalities in patientswith glial neoplasms. Mayo Clin Proc 1987; 62: 450–459.CrossRefGoogle Scholar
30. Stack, J, Antoun, N, Jenkins, J, Metcalfe, R, Isherwood, I. Gadolinium-DTPA as a contrast agent in magnetic resonance imaging of thebrain. Neuroradiology 1988; 30: 145–154.Google Scholar
31. Kelly, P. Volumetric stereotactic surgical resection of intra-axialbrain mass lesions. Mayo Clin Proc 1988; 63: 1186–1198.Google Scholar
32. Kilgore, D, Breger, R, Daniels, D, et al. Cranial tissues: normal MRappearance after intravenous injection of Gd-DTPA. Radiology 1986; 160: 757–761.CrossRefGoogle Scholar
33. Chamberlain, M, Murovic, J, Levin, V. Absence of contrastenhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 1988; 38: 1371–1374.CrossRefGoogle Scholar
34. Kondziolka, D, Lunsford, L, Martinez, A. Unreliability ofcontemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg 1993; 79: 533–536.Google Scholar
35. Kaschten, B, Stevenaert, A, Sadzot, B, et al. Preoperative evaluationof 54 gliomas by PET with fluorine-18-fleurodeoxyglucoseand/or carbon-11-methionine. J Nucl Med 1998; 39: 778–785.Google Scholar
36. Byrne, T. Imaging of gliomas. Semin Oncol 1994; 21: 162–171.Google ScholarPubMed
37. Francavilla, T, Miletich, R, Dichiro, G, et al. Positron emissiontomography in the detection of malignant degeneration of low-grade gliomas. Neurosurgery 1989; 24: 1–5.Google Scholar
38. Hwang, J, Egnaczyk, G, Ballard, E, et al. Proton MR spectroscopiccharacteristics of pediatric pilocytic astrocytomas. AJNR Am J Neuroradiol 1998; 19: 535–540.Google Scholar
39. Vigneron, D, Bollen, A, McDermott, M, et al. Three-dimensionalmagnetic resonance spectroscopic imaging of histologically confirmed brain tumours. Magn Reson Imaging 2001; 19: 89–101.Google Scholar
40. Mundinger, F, Weigel, K. Considerations in the usage and results ofcurietherapy. In: Lunsford, L, (Ed.) Modern Stereotactic Neurosurgery. Boston: Martinus Nijhoff, 1988: 245–258.Google Scholar
41. Karim, A, Afra, D, Cornu, P, et al. Randomized trial on the efficacy ofradiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer study 22845 with the Medical Research Council study BR04: aninterim analysis. Int J Radiat Oncol Biol Phys 2002; 52: 316–324.Google Scholar
42. Shaw, E, Scheithauer, B, O’Fallon, J. Supratentorial gliomas: acomparative study by grade and histologic type. J Neurooncol 1997; 31: 273–278.Google Scholar
43. Smith, JS, Perry, A, Borell, TJ, Lee, HK, et al. Alterations ofchromosome arms 1p and 19q as predictors of survival in oligo-dendrogliomas, astrocytomas, and mixed oligoastrocytomas. J Clin Oncol 2000; 18: 636–645.CrossRefGoogle Scholar
44. Kreth, F, Faist, M, Rossner, R, Volk, B, Ostertag, C. SupratentorialWorld Health Organization Grade 2 astrocytomas and oligoastrocytomas. A new pattern of prognostic factors. Cancer 1997; 79: 370–379.Google Scholar
45. Scerrati, M, Roselli, R, Iacoangeli, M, Pompucci, A, Rossi, G. Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery. J Neurol Neurosurg Psychiatry 1996; 61: 291–296.CrossRefGoogle ScholarPubMed
46. Janny, P, Cure, H, Mohr, M, et al. Low grade supratentorialastrocytomas. Cancer 1994; 73: 1937–1945.3.0.CO;2-G>CrossRefGoogle Scholar
47. van Veelen, M, Avezaat, C, Kros, J, van Putten, W, Vecht, C. Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 1998; 64: 581–587.Google Scholar
48. Lote, K, Egeland, T, Hager, B, et al. Survival, prognostic factors, andtherapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 1997; 15: 3129–3140.Google Scholar
49. Karim, A, Matt, B, Hatlevoli, R, et al. A randomized trial no 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 1996; 36: 549–556.CrossRefGoogle ScholarPubMed
50. Medbery, C, Strauss, K, Steinberg, S, Cotelingam, J, Fisher, W. Low-grade astrocytomas: treatment results and prognostic variables. Int J Radiat Oncol Biol Phys 1988; 15: 837–841.CrossRefGoogle ScholarPubMed
51. Pignatti, F, van den Bent, M, Curran, D, et al. Prognostic factors forsurvival in adult patients with cerebral low-grade glioma. J Clin Oncol 2002; 20: 2076–2084.Google Scholar
52. Piepmeier, J. Observations on the current treatment of low-gradeastrocytic tumours of the cerebral hemispheres. J Neurosurg 1987; 67: 177–181.Google Scholar
53. Fadul, C, Wood, J, Thaler, H, et al. Morbidity and mortality ofcraniotomy for excision of supratentorial gliomas. Neurology 1988; 38: 1374–1379.CrossRefGoogle ScholarPubMed
54. Ciric, I, Ammirati, M, Vick, N, Mikhael, M. Supratentorial gliomas:s u rgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurgery 1987; 21: 21–26.Google Scholar
55. Salcman, M, Scholtz, H, Kaplan, RS, Kulik, S. Long-term survival inpatients with malignant astrocytoma. Neurosurgery 1985; 34: 213–220.CrossRefGoogle Scholar
56. Ammirati, M, Vick, N, Liao, Y, Ciric, I, Mikhael, M. Effect of extent ofsurgical resection on survival and quality of life in patients with supratentorial glioblastomasand anaplastic astrocytoma. Neurosurgery 1987; 21: 201–206.Google Scholar
57. Vecht, C, Avezaat, C, Putten, W, Eijkenboom, W, Stefanko, S. The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis of 243 patients. J Neurol Neurosurg Psychiatry 1990; 53: 466–471.Google Scholar
58. Berger, M, Deliganis, A, Dobbins, J, Keles, G. The effect of extent ofresection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 1994; 74: 1784–1791.Google Scholar
59. Laws, E, Taylor, W, Bergstralh, E, Okazaki, H, Clifton, M. Theneurosurgical management of low-grade astrocytoma. Clin Neurosurg 1986; 61: 665–673.Google Scholar
60. Wara, W. Radiation therapy for brain tumours. Cancer 1985; 55: 2291–2295.Google Scholar
61. Surma-Aho, O, Niemela, M, Vilkki, J, et al. Adverse long-term effectsof brain radiotherapy in adult low-grade glioma patients. Neurology 2001; 56: 1285–1290.CrossRefGoogle Scholar
62. Taphoorn, M, Schiphorst, A, Snoek, F, et al. Cognitive functions andquality of life in patients with low-grade gliomas: the impact of radiotherapy. Ann Neurol 1994; 36: 48–54.Google Scholar
63. Vigliani, M-C, Sichez, N, Poisson, M, Delattre, J-Y. A prospectivestudy of cognitive functions following conventional radiotherapy for supratentorial gliomas in young adults: 4-year results. Int J Radiat Oncol Biol Phys 1996; 35: 527–533.Google Scholar
64. Roelcke, U, von, JA, Hausmann, O, et al. Operated low gradeastrocytomas: a long term PET study on the effect of radiotherapy. J Neurol Neurosurg Psychiatry 1999; 66: 644–647.Google Scholar
65. Bruehlmeier, M, Roelcke, U, Amsler, B, et al. Effects of radiotherapyon brain glucose metabolism in patients operated on for low grade astrocytoma. J Neurol Neurosurg Psychiatry 1999; 66: 648–653.Google Scholar
66. Mason, W. Chemotherapy for low-grade gliomas. FORUM Trends in Experimental and Clinical Medicine 2000; 10: 95–104.Google Scholar
67. Mason, WP, Krol, GS, DeAngelis, LM. Low-grade oligodendro-glioma responds to chemotherapy. Neurology 1996; 46: 203–207.Google Scholar
68. Soffietti, R, Ruda, R, Bradac, GB, et al. PCV chemotherapy forrecurrentoligodendrogliomasand oligoastrocytomas. Neurosurgery 1998; 43: 1066–1073.Google Scholar
69. Macdonald, DR, Gaspar, L, Cairncross, J. Successful chemotherapyfor newly diagnosed aggressive oligodendroglioma. Ann Neurol 1990; 27: 573–574.Google Scholar
70. Soffietti, R. Chemotherapy with PCV for low grade nonenhancingoligodendrogliomas. Neurology 1999; 52 (Suppl. 2): A423.Google Scholar
71. Packer, R, Lange, B, Ater, J, et al. Carboplatin and vincristine forrecurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol 1993; 11: 850–856.Google Scholar
72. Brada, M, Viviers, L, Abson, C, et al. Phase II study of primarytemozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol 2003; 24: 1715–1721.Google Scholar
73. Quinn, J, Reardon, DA, Friedman, AH, et al. Phase II trial oftemozolomide in patients with progressive low-grade glioma. J Clin Oncol 2003; 21: 646–651.Google Scholar
74. Baumert, B, Stupp, R, van den Bent, M, Mason, W. Therapy withcontinuous temozolomide for low grade glioma, inclusion based on genetic classification: two study proposals of the EORTC (European Organization for Research and Treatment of Cancer). Neurooncology 2002; 4 (Suppl. 1): S7.Google Scholar