Low-Grade Gliomas - Current Concepts

 

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Abstract

Diffuse astrocytomas, oligodendrogliomas, and oligoastrocytomas (mixed gliomas) WHO grade II, pleomorphic xanthoastrocytomas (PXAs), pilocytic astrocytomas, and subependymal giant cell astrocytomas (SEGAs) are often referred to as low-grade gliomas. WHO grade II astrocytomas, oligodendrogliomas, and mixed gliomas are characterized by their infiltrative growth, frequent tumor recurrence and a more than 50 % risk for malignant progression. In contrast, pilocytic astrocytomas and SEGAs are circumscribed tumors amenable to a (radio)surgical cure. There are few universally accepted guidelines for the treatment of low-grade gliomas. In this review, three neurosurgeons, a neurologist, a neuropathologist, and a radiation oncologist discuss some of the difficult issues surrounding the diagnosis and treatment of low-grade gliomas from their individual points of view (i. e., classification and neuropathology, MR imaging, stereotactic biopsy, microsurgery, interstitial radiotherapy/brachytherapy, radiotherapy, wait and see strategy).

Zusammenfassung

Diffuse Astrozytome, Oligodendrogliome und Oligoastrozytome WHO Grad II, pleomorphe Xanthoastrozytome, pilozytische Astrozytome und subependymale Riesenzell-Astrozytome (SEGAs) werden oft als niedriggradige Gliome zusammengefasst. WHO-Grad-II-Astrozytome, Oligodendrogliome und gemischte Gliome sind durch ihr infiltratives Wachstum, ihre ausgeprägte Rezidivneigung und ein über 50 %-iges Risiko der Malignisierung gekennzeichnet. Im Gegensatz dazu sind pilozytische Astrozytome und SEGAs umschriebene Tumoren, die sich mit chirurgischen oder radiochirurgischen Methoden auch heilen lassen. Es gibt wenige universell akzeptierte Leitlinien für die Behandlung niedriggradiger Gliome. In dieser Übersicht werden von drei Neurochirurgen, einem Neurologen, einem Neuropathologen und einem Strahlentherapeuten die schwierigen Aspekte der Diagnose und Behandlung niedriggradiger Gliome andiskutiert und dargestellt. Es ist dies nicht der Versuch, ein einheitliches abgestimmtes Konzept zur Therapie darzustellen, sondern es handelt sich um individuelle Standpunkte aus den verschiedenen Fachgebieten zu den Aspekten Klassifikation und Neuropathologie, Bildgebung, stereotaktische Biopsie, Mikrochirurgie, interstitielle Radiotherapie, Radiotherapie und schließlich noch zur abwartenden und beobachtenden Haltung. Die offene Darstellung durchaus auch miteinander konkurrierender Konzepte reflektiert die aktuelle Realität in der Therapie niedriggradiger Gliome.

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J. SchrammMD 

Department of Neurosurgery · University of Bonn

Sigmund-Freud-Str. 25

53105 Bonn

Germany

Phone: +49/2 28/2 87 65 00

Fax: +49/2 28/2 87 65 73

Email: Autor.Schramm@ukb.uni-bonn.de