The treatment of newly diagnosed low grade gliomas (LGG) remains controversial. Recently published results from the long-term follow up of Radiation Therapy Oncology Group (RTOG) trial 9802 demonstrated medically meaningful and statistically significant survival prolongation by adding chemotherapy with procarbazine, lomustine, and vincristine (PCV) after radiotherapy vs. radiotherapy alone for “high” risk patients (median 13.3 vs. 7.8 years, HR 0.59, p=0.03). However, in the 17 years since that trial was launched there have been advances in the understanding of LGG biology and patient heterogeneity, an increased recognition of late neuro-cognitive injury from early radiotherapy and the emergence of temozolomide as an alternative chemotherapy to PCV. These and other changes in the treatment landscape make the applicability of results from RTOG 9802 to all patients less clear. Moreover, in some patients, especially those at the lowest risk for early disease progression, deferred radiotherapy in favor of active surveillance or chemotherapy alone may remain reasonable treatment approaches.
展开▼
