Low-Grade Gliomas: To Treat or Not to Treat?

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Abstract
We thank Dr Shaw for his reply to our "controversial consensus."1He cautions that diffuse (ie, nonpilocytic) low-grade glioma of the cerebral hemispheres is a serious progressive illness, indolent compared with glioblastoma multiforme, but hardly trivial. Backed by data from the Mayo Clinic and elsewhere, he argues that early accurate diagnosis followed by careful limited-field radiotherapy is the best treatment for these tumors. He acknowledges the potential for delayed toxicity due to treatment but states that the side effects of modern radiotherapy are overemphasized. He concludes that radiotherapy is unquestionably of benefit and identifies radiation dose as the critical issue in the modern treatment of low-grade glioma of the cerebral hemispheres. Shaw et al2have demonstrated in a careful retrospective analysis that postoperative radiotherapy significantly prolongs the survival of patients with supratentorial low-grade nonpilocytic astrocytoma (including oligoastrocytoma). Patients were ascertained by reviewing the Tissue Registry at the Mayo Clinic.

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