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Low-Grade Gliomas pp 159–182Cite as

Is there a place for radiotherapy in low-grade gliomas?

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Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 35))

Abstract

The optimal management of supratentorial low-grade glioma remains controversial, and only limited definitive data is available to guide recommendations. Treatment decisions have to take into account both the management of symptoms and of tumour control, and must balance the benefits against the potential for treatment-related complications. Overall outcome is more dependent on patient and tumour-related characteristics such as age, tumour grade, histology and neurological function than treatment. From the pooled analysis of 2 randomized EORTC trials a prognostic score has been derived, median survival is varying from 3.2 to 7.8 years. Radiation therapy is usually the primary treatment modality; however its benefit on initial tumour control may be outweighed by potential late toxicity. To date only 4 large randomized trials in patients with low-grade glioma have been reported. It allows concluding that early radiotherapy does not improve overall survival and supports an initially expectative approach. Similarly, higher radiation doses above 45–50Gy (fractions of 1.8–2.0 Gy) do not confer a better outcome but may be associated with increased toxicity. The adjuvant use of PCV-chemotherapy in high-risk patients also failed to improve progressionfree and overall survival. An ongoing large randomized EORTC=NCIC trial is investigating the primary treatment with temozolomide chemotherapy versus standard radiotherapy in patients “at need for treatment”. Tumour material will be collected in all patients, which ultimately may allow identifying on a molecular basis patients for whom one or another treatment strategy may fit best. Irrespective of new chemotherapeutic agents, radiotherapy is also evolving. Highly conformal techniques based on modern imaging as co-registered MRI scans, limiting the amount of normal tissue irradiated without compromising tumour control, will be the future approach in order to reduce neurotoxicity.

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  1. Department of Radiation-Oncology (MAASTRO), Grow (School for Oncology and Developmental Biology), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands

    B. G. Baumert

  2. Department of Oncology-Haematology, Hospitals Riveria-Chablais, Vevey and Department of Neurosurgery, University of Lausanne (CHUV), Lausanne, Switzerland

    R. Stupp

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Baumert, B.G., Stupp, R. (2010). Is there a place for radiotherapy in low-grade gliomas?. In: Schramm, J. (eds) Low-Grade Gliomas. Advances and Technical Standards in Neurosurgery, vol 35. Springer, Vienna. https://doi.org/10.1007/978-3-211-99481-8_6

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