Low-grade glioma

Local tumour control is the cornerstone in the general management of childhood low-grade glioma. Treatment traditionally consists of surgery and biopsy in areas not amenable to resection. Non-surgical treatment is usually performed upon progression. Although chemotherapy is increasingly used as first non-surgical treatment, radiotherapy remains standard as salvage treatment or as primary treatment in selected cases in which surrounding normal tissue can be optimally preserved. The effects of chemotherapy on improving the clinical, neurological, visual and endocrinological function deserve further investigation. Recent improvements in radiotherapy treatment and delivery techniques allow better coverage of target volume and assure maximal tumour control while sparing as much normal tissue as possible to reduce the risk of toxicity secondary to treatment. Additionally, the implementation of modern imaging technologies including functional imaging permits a better identification of the tumour site and neighbouring normal tissue or organs at risk thereby further reducing the risk for late adverse effects. Intensitymodulated radiotherapy (IMRT), stereotactic high precision technologies and the introduction of proton therapy may further improve treatment outcome. Brachytherapy, or in rare cases radiosurgery, is a treatment option in low-grade glioma; however, clinical data are scarce and require more research. The role of targeted therapies is currently under investigation in clinical trials. New information on molecular genetic patterns in low-grade glioma may also have an impact on the selection and sequencing of radiotherapy.