The Impact of Surgical Treatment on Prognosis for Adult Patients Harbouring Supratentorial Low-Grade Glioma

Authors: A. Šteňo 1;  V. Belan 2;  P. Kalina 3;  M. Fabian 2;  J. Šteňo 1
Authors‘ workplace: LF UK a UN Bratislava Neurochirurgická klinika 1;  LF UK a UN Bratislava Rádiodiagnostická klinika 2;  LF UK a UN Bratislava II. Neurologická klinika 3
Published in: Cesk Slov Neurol N 2011; 74/107(3): 273-278
Category: Review Article


Adult supratentorial low-grade glioma (grade II. glioma) tends to malignant dedifferentiation and fatal outcome. In the absence of any prospective randomized study, the role of surgery in low-grade glioma treatment has been discussed for years. However, ethical considerations render comparative study of the matter very difficult to organise. Retrospective studies suffer from intrinsic selection bias, and the authors of early papers were unable to record reliable criteria for assessment of the extent of resection – operative reports and computer tomography. The result of such works were not consistent, so the role of surgical treatment was, and still is, controversial. However, several recent retrospective studies have assessed the extent of resection via reliable criteria – T2 and fluid-attenuated inversion recovery (FLAIR) magnetic resonance sequences. These verified improved prognosis after extensive low-grade glioma resection. Therapeutic strategy must be based on the best evidence available, so nowadays maximal safe surgical resection is recommended as the treatment of choice.

Key words:
low-grade glioma – surgical treatment – prognosis


1. Whittle IR. The dilemma of low grade glioma. J Neurol Neurosurg Psychiatry 2004; 75 (Suppl 2): ii31–ii36.

2. Whittle IR. What is the place of conservative management for adult supratentorial low-grade glioma? Adv Tech Stand Neurosurg 2010; 35: 65–79.

3. Zárubová J. Nízkostupňový gliom (fibrilární astrocytom) a epilepsie. Neurol pro praxi 2009; 10(5): 324–327.

4. Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P et al. Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 2002; 20(8): 2076–2084.

5. Johannesen TB, Langmark F, Lote K. Progress in long-term survival in adult patients with supratentorial low-grade gliomas: a population-based study of 993 patients in whom tumors were diagnosed between 1970 and 1993. J Neurosurg 2003; 99(5): 854–862.

6. McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 2008; 63(4): 700–707.

7. Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, Van Effenterre R et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry 2005; 76(6): 845–851.

8. Ahmadi R, Dictus C, Hartmann C, Zürn O, Edler L,Hartmann M. Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients. Acta Neurochir (Wien) 2009; 151(11): 1359–1365.

9. Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 2008; 26(8): 1338–1345.

10. Pouratian N, Schiff D. Management of low--grade glioma. Curr Neurol Neurosci Rep 2010; 10(3): 224–231.

11. Soffietti R, Baumert BG, Bello L, von Deimling A, Duffau H, Frénay M et al. Guidelines on management of low-grade gliomas: report of an EFNS-EANO* Task Force. Eur J Neurol 2010; 17(9): 1124–1133.

12. Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery 2008; 62(4): 753–764.

13. Perry A. Pathology of low-grade gliomas: an update of emerging concepts. Neuro Oncol 2003; 5(3): 168–178.

14. Schiffbauer H, Ferrari P, Rowley HA, Berger MS, Roberts TP. Functional activity within brain tumors: a magnetic source imaging study. Neurosurgery 2001; 49(6): 1313–1320.

15. Duffau H, Capelle L. Preferential brain locations of low-grade gliomas. Cancer 2004; 100(12): 2622–2626.

16. Mandonnet E, Pallud J, Fontaine D, Taillandier L, Bauchet L, Peruzzi P et al. Inter- and intrapatients comparison of WHO grade II glioma kinetics before and after surgical resection. Neurosurg Rev 2010; 33(1): 91–96.

17. Afra D, Osztie E, Sipos L, Vitanovics D. Preoperative history and postoperative survival of supratentorial low-grade astrocytomas. Br J Neurosurg 1999; 13(3): 299–305.

18. Frazier JL, Johnson MW, Burger PC, Weingart JD, Quinones-Hinojosa A. Rapid malignant transformation of low-grade astrocytomas: report of 2 cases and review of the literature. World Neurosurg 2010; 73(1): 53–62.

19. Chang EF, Smith JS, Chang SM, Lamborn KR, Prados MD, Butowski N et al. Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 2008; 109(5): 817–824.

20. Bartoš R, Sameš M, Julišová I, Derner M, Hladíková M. Supratentoriální gliom WHO grade II. Retro­spektivní studie 37 pacientů. Cesk Slov Neurol N 2003; 66/99(5): 355–360.

21. Houillier C, Mokhtari K, Carpentier C, Crinière E, Marie Y, Rousseau A. Chromosome 9p and 10q losses predict unfavorable outcome in low-grade gliomas. Neuro Oncol 2010; 12(1): 2–6.

22. Rees J, Watt H, Jäger HR, Benton C, Tozer D, Tofts Pet al. Volumes and growth rates of untreated adult low-grade gliomas indicate risk of early malignant transformation. Eur J Radiol 2009; 72(1): 54–64.

23. Brasil Caseiras G, Ciccarelli O, Altmann DR, Benton CE, Tozer DJ, Tofts PS et al. Low-grade gliomas: six-month tumor growth predicts patient outcome better than admission tumor volume, relative cerebral blood volume, and apparent diffusion coefficient. Radiology 2009; 253(2): 505–512.

24. Hentschel SJ, Lang FF. Surgical resection of intrinsic insular tumors. Neurosurgery 2005; 57 (Suppl 1): 176–183.

25. Talos IF, Zou KH, Ohno-Machado L, Bhagwat JG, Kikinis R, Black PM. Supratentorial low-grade glioma resectability: statistical predictive analysis based on anatomic MR features and tumor characteristics. Radiology 2006; 239(2): 506–513.

26. Rychlý B, Fabián M. Oligodendrogliové tumory: histologicko-rádiologické korelácie. Lek Obzor 2010; 5(59): 203–204.

27. Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ. Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 1987; 66(6): 865–874.

28. Bynevelt M, Britton J, Seymour H, MacSweeney E, Thomas N, Sandhu K. FLAIR imaging in the follow-up of low-grade gliomas: time to dispense with the dual-echo? Neuroradiology 2001; 43(2): 129–133.

29. Stadlbauer A, Buchfelder M, Doelken MT, Hammen T, Ganslandt O. Magnetic resonance spectroscopic imaging for visualization of the infiltration zone of glioma. Cen Eur Neurosurg. In press 2010.

30. Ganslandt O, Stadlbauer A, Fahlbusch R, Kamada K, Buslei R, Blumcke I et al. Proton magnetic resonance spectroscopic imaging integrated into image-guided surgery: correlation to standard magnetic resonance imaging and tumor cell density. Neurosurgery 2005; 56 (Suppl 2): 291–298.

31. BelanV, Pružincová Ľ, Srbecký M. MR v diagnostike a liečbe primárnych nádorov mozgu. Onkológia (Bratisl) 2010; 5(3): 138–141.

32. Pročka V, Makaiová I, Šteňo J, Kalina P, Belan V, Pružincová Ľ et al. Skúsenosti s využitím 18FDG PET v diferenciálnej diagnostike low-grade a high-grade gliómov. Onkológia (Bratisl) 2010; 5(3): 156–161.

33. van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K et al. Long-term efficacy of early versus delayed radiotherapy for low--grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 2005; 366(9490): 985–90.

34. Pružincová L, Šteňo J, Srbecký M, Kalina P, Rychlý B, Bolješíková E et al. MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay. Eur Radiol 2009; 19(11): 2716–2727.

35. Chorvath M, Boljesikova E, Pruzincova L, Procka V, Rychly B, Novotny M et al. Post-therapeutical changes in the brain: novel trends in imaging and their infuence on external beam radiotherapy. Neoplasma 2009; 56(2): 156–162.

36. Neyns B, Sadones J, Chaskis C, De Ridder M, Keyaerts M, Veld PI at al. The role of chemotherapy in the treatment of low-grade glioma. A review of the literature. Acta Neurol Belg 2005; 105(3): 137–143.

37. Murphy PS, Viviers L, Abson C, Rowland IJ, Brada M, Leach MO et al. Monitoring temozolomide treatment of low-grade glioma with proton magnetic resonance spectroscopy. Br J Cancer 2004; 90(4): 781–786.

38. Kesari S, Schiff D, Drappatz J, LaFrankie D, Doherty L, Macklin EA et al. Phase II study of protracted daily temozolomide for low-grade gliomas in adults. Clin Cancer Res 2009; 15(1): 330–337.

39. Pace A, Vidiri A, Galiè E, Carosi M, Telera S, Cianciulli AM et al. Temozolomide chemotherapy for progressive low-grade glioma: clinical benefits and radiological response. Ann Oncol 2003; 14(12): 1722–1726.

40. Kaloshi G, Benouaich-Amiel A, Diakite F, Taillibert S, Lejeune J, Laigle-Donadey F et al. Temozolomide for low-grade gliomas: predictive impact of 1p/19q loss on response and outcome. Neurology 2007; 68(21): 1831–1836.

41. Brada M, Viviers L, Abson C, Hines F, Britton J, Ashley S et al. Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Ann Oncol 2003; 14(12): 1715–1721.

42. Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E. Dynamic history of low-grade gliomas before and after temozolomide treatment. Ann Neurol 2007; 61(5): 484–490.

43. Mraček J, Choc M, Hes O, Vaněček T. Současná diagnostika a léčba oligodendrogliomú. Cesk Slov Neurol N 2008; 71/104(5): 537–543.

44. Bartoš R, Sameš M, Vachata P, Červenka M, Jech R, Vymazal J et al. Výsledky a tolerance „awake“ resekcí mozkových tumorů. Cesk Slov Neurol N 2005; 68/101(1): 39–45.

45. Bartoš R, Ceé J, Zolal A, Hejčl A, Bolcha M, Prokšová J et al. Extraoperativní mapování pomocí kortikálního gridu před resekcí difuzního oligodendrogliomu v řečově dominantní hemisféře – alternativa „awake kraniotomie“ – kazuistika. Cesk Slov Neurol N 2008; 71/104(6): 718–721.

46. Galanda M, Babicová A, Patráš F, Šulaj J, Béreš A. Peroperačná elektrická stimulácia pri operáciách v centrálnych oblastiach mozgu a v mieche. Cesk Slov Neurol N 2001; 64/97(5): 338–343.

47. Šteňo A, Čík M. Šteňo J. Súčasný technický pokrok v neurochirurgii a jeho vplyv na chirurgickú liečbu gliových nádorov mozgu. Onkológia (Bratisl) 2010; 5(3): 132–137.

48. Filip M, Paleček T, Starý R, Lipina R, Mrůzek M, Školoudík D et al. Ultrazvukový peroperační monitoring glioblastomů v 2D obraze a reálním čase. Cesk Slov Neurol N 2004; 67/100(1): 42–46.

49. Unsgaard G, Ommedal S, Muller T, Gronningsaeter A, Nagelhus Hernes TA. Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection. Neurosurgery 2002; 50(4): 804–812.

50. Ostrý S., Stejskal L. Evokované odpovědi a elektromyografie v intraoperační monitoraci v neurochirurgii. Cesk Slov Neurol N 2010; 73/106(1): 8–19.

51. Schneider JP, Schulz T, Schmidt F, Dietrich J, Lieberenz S, Trantakis C et al. Gross-total surgery of supratentorial low-grade gliomas under intraoperative MR guidance. AJNR Am J Neuroradiol 2001; 22(1): 89–98.

52. Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F et al. Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 2005; 103(6): 1227–1233.

53. Jackson RJ, Fuller GN, Abi-Said D, Lang FF, Gokaslan ZL, Shi WM et al. Limitations of stereotactic biopsy in the initial management of gliomas. Neuro Oncol 2001; 3(3): 193–200.

54. Philippon JH, Clemenceau SH, Fauchon FH, Foncin JF. Supratentorial low-grade astrocytomas in adults. Neurosurgery 1993; 32(4): 554–559.

55. Rajan B, Pickuth D, Ashley S, Traish D, Monro P, Elyan S et al. The management of histologically unverified presumed cerebral gliomas with radiotherapy. Int J Radiat Oncol Biol Phys 1994; 28(2): 405–413.

56. van Veelen ML, Avezaat CJ, Kros JM, van Putten W, Vecht C. Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 1998; 64(5): 581–587.

57. Nakamura M, Konishi N, Tsunoda S, Nakase H, Tsuzuki T, Aoki H. Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults. Oncology 2000; 58(2): 108–116.

58. Yeh SA, Ho JT, Lui CC, Huang YJ, Hsiung CY, Huang EY. Treatment outcomes and prognostic factors in patients with supratentorial low-grade gliomas. Br J Radiol 2005; 78(927): 230–235.

59. Leighton C, Fisher B, Bauman G, Depiero S, Stitt L, MacDonald D et al. Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 1997; 15(4): 1294–1301.

60. Scerrati M, Roselli R, Iacoangeli M, Pompucci A, Rossi GF. Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery. J Neurol Neurosurg Psychiatry 1996; 61(3): 291–296.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2011 Issue 3

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account