Grade 1 Gliomas

Grade 1 gliomas are central nervous tumors of glial origin, slow growth rate and having a long-term survival. Apart from pilocytic astrocytoma, which is the most common tumor type in this category, occurring largely in children, several other glial or mixed neuronal-glial tumors are defined. They are sometimes associated with genetic mutations and familial syndromes, awareness of which is a key component of planning management. Surgery is the main treatment modality and serves the dual purpose of symptom relief as well as guidance for adjuvant therapy, if needed, depending on histopathological characteristics. Various considerations including symptom control, morbidity of treatment, and long-term impact on quality of life are necessary when planning management due to long-term survival and young cohort of patients. Several systemic therapies are under investigation based on the observed targetable genetic mutations and pathways. Radiation therapy, when necessary, needs to strike a balance between maximizing local control and minimizing treatment volumes and dose to reduce the long-term adverse events. Future studies on any modality of therapy need to take into account neurocognitive and neuroendocrine effects in addition to patient reported outcomes.