How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?

Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...

One should first determine the reason that the tumor was sub-totally resected. A common reason is that the tumor is close to an eloquent area of the brain. If that is the case, I would recommend treatment because a tumor recurrence could cause functional deficit by invading the adjacent eloquent are...

The management for classic WHO grade 2 gliomas is increasingly becoming complex, especially with recent results from the INDIGO trial. In the context of this patient, there are two favorable risk factors, i.e. age <40, and IDH mutated, also but the fact that there are two unfavorable risk factors, i...

A patient with LGG, IDHm, <40 yo, who has had a subtotal resection would qualify for high risk on the basis of the sub-total resection per RTOG 9802 eligibility criteria. On that trial, he would have been randomized to RT vs RT+PCV chemo.

This trial showed a significant improvement in the PFS but not...

This is an evolving area of neuro-oncology. For a healthy 40-year-old with a subtotal resection of an incidentally found LGG, IDHm astrocytoma:

• If the residual tumor is substantial and/or the pathology is IDH-mutant astrocytoma, I would generally recommend: postoperative RT (54 Gy in 30 fractions) f...