Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

Surgical resection and observation

5 evidence topics · 6 sources

Surgery as initial treatment and observation after incomplete resection

“Around 40% of all LGG patients can be cured by complete neurosurgical resection and are followed by close observation. In case of relapse, second resection often is possible. Following incomplete resection observation is recommended, as long as there is no radiologic tumor growth and the patient does not suffer from significant, tumor-related symptoms.” (opens the source at this quote in a new tab)
“By contrast, clinical worsening and / or radiologic progression are an indication to treatment with either chemo- or radiotherapy.” (opens the source at this quote in a new tab)

“The CCG9891/POG9130 study reported a 5-year PFS and OS of 94% and 99% respectively in children with confirmed gross total resection.2 However, many tumours are not amenable to complete resection because of anatomical location and /or metastatic disease.” (opens the source at this quote in a new tab)

“Surgical resection is the mainstay of front-line therapy for symptomatic pLGG; however, more than 50% of pLGGs occur in locations that are either not amenable to surgery or only amenable to a biopsy or limited resection (e.g. tumors located in the diencephalon, brainstem, optic pathway, or spinal cord) (8).” (opens the source at this quote in a new tab)

Indications to start non-surgical treatment in unresectable pLGG

Category	Indication
Radiologic criteria	“Increase of tumour volume of > 25 %”
Neurologic symptoms	“Diencephalic syndrome”
Neurologic symptoms	“Focal neurologic deficits subsequent to tumour growth”
Infants	“Infants below 12 months of age with chiasmatic-hypothalamic tumours”
Ophthalmologic symptoms	“Visual deterioration on follow-up, a significant loss is defined as more than or equal to 0.2 LogMAR”

Brazilian consensus: surgery and molecular testing

“Maximal safe surgical resection remains the cornerstone of treatment for low-grade gliomas (LGG).10 However, precision medicine strategies can inform prognosis and therapeutic decision-making, especially in cases of progressive or recurrent disease.” (opens the source at this quote in a new tab)
“LGG1 | For low-grade gliomas, regardless of histological subtype, BRAF gene fusions and BRAF V600E mutation testing should be performed as part of the molecular evaluation.” (opens the source at this quote in a new tab)

Vision loss as the indication for starting chemotherapy in the SIOP-LGG 2004 UK optic pathway glioma cohort

“VA loss was the most frequent indication to initiate therapy in both NF1 (n=34 eyes, 74%) and sporadic (n=39 eyes, 89%) groups.” (opens the source at this quote in a new tab)
“Early treatment was initiated in both NF1 and sporadic groups; median time from diagnosis to initiation of treatment was 35 and 21 days, respectively, with 77% and 93% of subjects, respectively, receiving treatment within 1 year of diagnosis.” (opens the source at this quote in a new tab)

Published 2024 recommendations add criteria to start non-surgical treatment beyond the 2022 draft

“Drug resistant seizures with or without tumour growth” (opens the source at this quote in a new tab)
“Symptomatic metastases” (opens the source at this quote in a new tab)
“Borderline vision (“Threat to vision”)” (opens the source at this quote in a new tab)
“Any visual loss in the second eye when the first eye is blind” (opens the source at this quote in a new tab)