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November 1989

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

Author Affiliations

From the Departments of Clinical Neurological Sciences and Oncology, University of Western Ontario, and London Regional Cancer Centre, London, Ontario (Dr Cairncross); and the Department of Radiology, University of Toronto (Ontario), and the Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario (Dr Laperriere).

Arch Neurol. 1989;46(11):1238-1239. doi:10.1001/archneur.1989.00520470106035

We believe there is insufficient evidence to justify the aggressive treatment (ie, surgery, radiotherapy, and chemotherapy) of all low-grade gliomas of the cerebral hemispheres. The indolent nature of these tumors makes it difficult, in the absence of a properly controlled clinical trial, to evaluate the true effectiveness of intervention. Conclusions and recommendations based solely on the analysis of retrospective data are suspect. Further, the indolent course of these neoplasms raises the possibility that the potential benefits of treatment will, in the long run, be offset by treatment-related toxic effects.

We state at the outset that surgery has an important role to play in the treatment of selected patients and specific types of low-grade gliomas. For example, surgery is the principal treatment for childhood cystic astrocytoma of the cerebellum. Surgery may be lifesaving in patients with large hemispheric tumors or cysts and threatened herniation. Surgery may be necessary to relieve cerebrospinal

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