How do you approach treatment of a subtotally resected low grade glioma in a young patient?

The management philosophy for LGG is radically shifting. For years, the belief was that these were essentially "incurable", slow-growing tumors, and hence the original debate centered around observation versus resection; the observation camp is now squarely in the minority. The debate then shifted t...

Given RTOG9802 showed OS benefit for RT/chemotherapy vs RT alone, which also included those with age <40 and STR, I would favor adjuvant RT AND chemotherapy (Buckner et al, NEJM 2016). Furthermore, there is this new diagnostic criteria based on CIMPACT-NOW consensus that low grade IDH-wildtype astro...

Excellent discussion below. Given that the early vs. delayed XRT shows improvement in seizure-free survival, I think that earlier XRT is particularly beneficial for patients with seizures or large unresected or partially lesions that are already symptomatic. In my experience these large lesions are ...

In a young patient with a subtotally resected low grade glioma, I give the options of radiation therapy now vs at the time of symptomatic or imaging progression. In general, I favour delayed radiation therapy given the results of the European study that showed no change in survival outcomes. At the ...

As stated above 9802 RT+PCV demonstrated survival advantage over RT alone which took years to see the OS benefit, implying a durable benefit to upfront treatment. So any high risk feature low grade glioma should be considered for adjuvant RT.

In terms of molecular factors, several excellent articles...