Dixit Karan, Raizer Jeffrey
Oncology (Williston Park). 2017 Sep 15;31(9):680-2, 684-5.
Low-grade gliomas are infiltrative primary brain tumors that most commonly occur in young adults. They are relatively slow growing compared with high-grade gliomas. The World Health Organization classification system was updated in 2016 to define low-grade gliomas using molecular markers in addition to histology. IDH mutation is an independent marker associated with better outcomes. Management is individualized based on tumor histology, molecular characterization, and patient risk factors. Given the longer course and natural history of low-grade gliomas, the goals of treatment should be to prolong overall survival and minimize neurocognitive decline. Early maximum safe resection is the first line of treatment. While low-risk patients may be followed with observation after surgery, patients with high-risk factors (subtotal resection, age > 40 years, IDH wild-type tumors) should be treated with radiation and chemotherapy. Improved understanding of the molecular characteristics of low-grade gliomas will further guide risk stratification and allow the identification of treatment approaches that are more effective and less toxic.
低级别胶质瘤是浸润性原发性脑肿瘤，最常见于年轻人。与高级别胶质瘤相比，它们的生长相对缓慢。2016年世界卫生组织分类系统进行了更新，除了组织学外，还使用分子标志物来定义低级别胶质瘤。异柠檬酸脱氢酶（IDH）突变是与更好预后相关的独立标志物。治疗方案根据肿瘤组织学、分子特征和患者风险因素进行个体化制定。鉴于低级别胶质瘤病程较长和自然病史，治疗目标应是延长总生存期并尽量减少神经认知功能下降。早期最大安全切除是一线治疗方法。虽然低风险患者术后可进行观察，但具有高风险因素（次全切除、年龄>40岁、IDH野生型肿瘤）的患者应接受放疗和化疗。对低级别胶质瘤分子特征的进一步了解将进一步指导风险分层，并有助于确定更有效且毒性更小的治疗方法。
