Purpose of review: The management of low-grade gliomas (grade II WHO) is still controversial, due to the rarity of these tumors and continuous advances in molecular diagnosis and new technologies for treatment. This article reviews the current understanding of management of grade II gliomas in light of the recent clinical and translational studies.
Recent findings: The role of an extensive surgery at onset is now fully recognized. Recent clinical trials in the USA and Europe have demonstrated the importance of chemotherapy either in association with radiotherapy or as initial treatment to delay the risk of cognitive defects following radiation. Molecular factors, such as IDH1 or 2 mutations and 1p/19q codeletion, are favorable prognostic factors, and seem to predict a better response to chemotherapy as well. The role of conventional therapeutic options (surgery, radiotherapy, chemotherapy), in various combinations or sequences, has been better defined by clinical trials, but still there are areas of controversy. A future challenge is to reevaluate the role of these options within the different molecular subgroups of prognostic significance according to the last WHO classification of CNS tumors of 2016.
Keywords: Chemotherapy; Combination therapy; Low-grade gliomas; Monotherapy; New molecular subgroups; Radiotherapy; Sequential therapy; Surgery.