2018 Volume 27 Issue 2 Pages 82-90
The new 2016 WHO brain tumor classification defines diffuse gliomas according to their IDH mutations and 1p/19q codeletion status. The diagnosis of oligodendroglioma requires both IDH mutations and 1p/19q codeletion. Oligoastrocytomas are categorized as either astrocytoma or oligodendroglioma, based on their IDH and 1p/19q status. Grade Ⅱ glioma is a progressive tumor and tends to develop malignant progression. Extensive and early surgical resection could improve patients’ outcome, but it should be noted that tumor recurrence often occurs even after total resection. Radiotherapy plays an important role in the treatment of grade Ⅱ or Ⅲ glioma, but long-term neurocognitive sequelae remain a serious problem. Recent clinical trials have shown a survival benefit from adding chemotherapy to radiotherapy compared with initial treatment using radiotherapy alone in grade Ⅱ or Ⅲ gliomas. The combination of procarbazine, lomustine, and vincristine has been shown to be effective. Several clinical trials, including temozolomide, are underway in Europe, U.S.A, and Japan. The optimal chemotherapeutic treatment will be determined following these. In the future, a molecular-based approach will define the tumor more narrowly, identify biomarkers, which predict the benefit of chemotherapy, develop targeted therapy, and eventually improve patients’ outcomes.
