Stereotactic Radiosurgery for Low-grade Glioma: A Systematic Review

Introduction: Low-grade gliomas (LGGs) are slow-growing primary brain tumors that present unique treatment challenges, especially when resection near eloquent area is limited. Although maximal or supramaximal safe resection remains the cornerstone of treatment, the role of adjuvant therapies, such as stereotactic radiosurgery (SRS) is less defined. This systematic review synthesizes the current literature on SRS in managing pathology-proven LGGs, focusing on advancements and treatment outcomes.

Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of PubMed, Scopus and Web of Science was completed in August 2024 using the keywords “radiosurgery” AND “low-grade glioma”. Only studies involving pathology-proven LGGs were included, and relevant data were extracted from eligible studies.

Results: Eight observational studies, encompassing 373 patients with confirmed LGGs, met the inclusion criteria. Patient age ranged from 16 to 50.5 years, with follow-up periods spanning 32 to 96 months. SRS protocols varied, with median marginal doses between 13 to 25 Gy. Gamma Knife was the most commonly used platform. Tumor control rates ranged from 67% to 86%, while 5-year progression-free survival (PFS) rates were between 41% and 88%. Adverse events were reported in 12.5% to 44% of patients, primarily as mild-to-moderate symptoms.

Conclusion : SRS demonstrates potential as an effective adjuvant therapy for pathology-proven LGGs, offering favorable tumor control rates and prolonged PFS. This review highlights the role of SRS as a non-invasive option that complements existing treatment strategies, supporting its integration into multimodal management approaches for LGGs.