Abstract
INTRODUCTION: Low grade gliomas (LGG) are slow growing tumours, with the potential of transforming into aggressive high grade gliomas. Treatment of LGG must balance risk of malignant transformation against morbidity of early aggressive treatment. We evaluated the variation in management of low grade gliomas in the UK. METHOD: A survey was sent to all adult UK neurosurgery units, addressing surgical technology, treatment choice and surveillance. 23 units participated (82% participation rate). RESULTS: All LGG patients are discussed in an MDT meeting at initial presentation. 11 units manage patients in neurosurgical oncology clinics, and 6 units had dedicated LGG clinics. Others manage patients in general neurosurgical (3), combined (2) and oncology (1) clinics. The majority of centres use intra-operative ultrasound (20) and functional MRI (19) for motor and language mapping. 11 units use intra-operative EMG. Post-operative surveillance imaging intervals range from 3 to 12 months. Most units have multimodal MRI to detect tumour transformation, but do not always use them. Only 5 units use volumetric changes and 5 use PET imaging. Two clinical scenarios were also given: for a peripheral LGG, all units would consider resection followed by surveillance. Variable responses were given for an insular LGG: 9 would manage only with active surveillance, 6 would consider resection followed by surveillance. The rest choose to biopsy, followed by surveillance (4) or radiotherapy (4). CONCLUSION: This study demonstrates variable management of LGG across the UK, particularly surveillance intervals and of tumours in eloquent areas. More research to stratify transformation risk can help guide optimal treatment.