In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?

As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons:

1. Observation: We do know that in resected patients, radi...

The answer to this question depends on how long it took for the LGG to recur after the first GTR and also on several other criteria such as the size of the recurrence (> or <5 cm), location within the brain (e.g., frontal lobe versus parietal lobe), proximity to eloquent parts of the brain which cou...

Agree with @Dr. First Last and @Dr. First Last's statements. It is a particularly challenging scenario, especially now that we have IDH inhibition available. In a vacuum of clear-cut guidelines, it is worth a discussion with the patient. Not all recurrent low-grade gliomas are created equal. As Dr. ...

I agree with Dr. @Dr. First Last's considerations. My concerns would weigh on how long it took to recur, as well as the location of the lesion.

A longer interval between the initial resection might lean me towards observation, while a quicker recurrence would prompt treatment. Additionally, if the l...

I approach these patients with my own treatment-related biases to avoid RT for as long as possible, since the risk for late and irreversible adverse effects increases with time. Patients with >10-year survivals are more likely to suffer from RT (RT necrosis, ICH, stroke, or cognitive decline) than t...