Prognostic Factors and Treatment Strategies in Low-Grade Gliomas

Low-grade gliomas (LGGs) are diffuse World Health Organization grade II tumours arising from glial cells in the central nervous system. Patient prognosis is influenced by clinical factors such as age at diagnosis and extent of surgical resection, as well as molecular markers including isocitrate dehydrogenase (IDH) mutation status and 1p/19q codeletion. Advances in imaging and histopathology enable more precise risk stratification, guiding decisions on adjuvant therapies. Radiotherapy remains a mainstay for patients with residual disease or high-risk features, while chemotherapy regimens—commonly temozolomide or a combination of procarbazine, lomustine and vincristine—are selected based on molecular subtype and anticipated tolerability. Emerging approaches such as proton and heavy-ion beam therapies aim to minimise collateral toxicity, and predictive models employing genomic and clinical inputs are under development to personalise adjuvant treatment. A multidisciplinary strategy that integrates surgical, molecular and patient-centred considerations seeks to optimise long-term survival, preserve neurologic function and maintain quality of life.

Research from Nature Portfolio

Recent studies have applied deep learning to molecular profiles to predict early progression in IDH-mutant gliomas. One investigation developed an artificial neural network incorporating patient age, mutation status of TP53 and ATRX, and copy number variations of EGFR, PTEN and CDKN2A to generate a risk score that identifies high-risk IDH-mutant patients with over 90 per cent accuracy. This tool offers a foundation for selecting individuals most likely to benefit from adjuvant radiotherapy.

Age-related analyses of diffuse gliomas have revealed that older patients, particularly those with wild-type IDH, present with more aggressive radiological features and neuropathological markers, including increased contrast-enhancing tumour volume. For each additional year of patient age, progression-free survival is reduced by approximately nine days, underscoring the need to tailor therapeutic intensity according to both chronological age and molecular subtype.

Prognostic Factors and Treatment Strategies in Low-Grade Gliomas publication trend

The graph below shows the total number of articles in prognostic factors and treatment strategies in low-grade gliomas across all publications each year (not limited to Nature Index journals).

Technical terms

Low-grade glioma (LGG): A diffuse primary brain tumour of WHO grade II arising from glial cells with generally slower growth than high-grade gliomas.

IDH mutation: A change in the isocitrate dehydrogenase enzyme that defines molecular subgroups of glioma with prognostic and therapeutic implications.

1p/19q codeletion: Combined loss of chromosomal arms 1p and 19q characteristic of oligodendrogliomas, associated with favourable response to therapy.

Copy number variation (CNV): A genomic alteration involving duplication or deletion of DNA segments that can affect oncogene or tumour suppressor dosage.

Proton therapy: A form of external beam radiotherapy using protons to deliver conformal doses with reduced exit dose beyond the tumour.

Temozolomide: An oral alkylating agent widely used as adjuvant chemotherapy in glioma management.

Artificial neural network (ANN): A computational model inspired by biological neural networks, used here to integrate multidimensional data for risk prediction.

References

1. Oncological Outcomes, Long-Term Toxicities, Quality of Life and Sexual Health after Pencil-Beam Scanning Proton Therapy in Patients with Low-Grade Glioma. Cancers (2023).
2. Current standards and the future role of hadrontherapy in the treatment of central nervous system tumors. Health and Technology (2024).
3. GlioPredictor: a deep learning model for identification of high-risk adult IDH-mutant glioma towards adjuvant treatment planning. Scientific Reports (2024).
4. Longitudinal assessment of quality of life, neurocognition, and psychopathology in patients with low-grade glioma on first-line temozolomide: A feasibility study. Neuro-Oncology Advances (2024).
5. Age is associated with unfavorable neuropathological and radiological features and poor outcome in patients with WHO grade 2 and 3 gliomas. Scientific Reports (2021).