First Mexican consensus guideline for the management of IDH-mutant low-grade gliomas: Mexican guidelines for IDH-mutant gliomas
Mónica Serrano-Murillo, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
Enrique Caballe-Pérez, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
Alberto González-Aguilar, Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirgía Manuel Velasco Suárez, Mexico City, Mexico
Talia Wegman-Ostrosky, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
Marco A. Rodríguez-Florido, Anatomía Patológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
Alejandro Rodríguez-Camacho, Subdirección de Radioterapia, Instituto Nacional de Cancerología, Mexico City, Mexico
Sergio Moreno-Jiménez, Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirgía Manuel Velasco Suárez, Mexico City; Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City;; Mexico
Federico Maldonado-Magos, Subdirección de Radioterapia, Instituto Nacional de Cancerología, Mexico City, Mexico
Alan O. Chávez-Martínez, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
Pedro R. Corona-Cedillo, Neuroimagen, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Héctor A. Montenegro-Rosales, Neuroradiología intervencionista, Fundación Médica Sur, Mexico City, Mexico
Guillermo A. Gutiérrez-Aceves, Servicio de Radioneurocirugia, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
Alexandra Diaz-Alba, Neuro-Oncology Unit, Instituto Jaliscience de Cancerología, Guadalajara, Jalisco, México
Norma C. Aréchiga-Ramos, Grupo de estudio de Neuro-Oncología, Academia Mexicana de Neurología, Mexico City; Unidad de Neuro-oncología, Centro Médico ABC, Mexico City; Mexico
Oscar Arrieta, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
Alipio Gonzalez-Vazquez, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
Bernardo Cacho-Díaz, Unidad Funcional de Neuro-Oncología, Instituto Nacional de Cancerología, Mexico City, Mexico
The objective of the study is to propose a diagnostic and therapeutic algorithm for patients with mIDH-LGG tailored to our country’s healthcare setting. Patients with isocitrate dehydrogenase-mutant (mIDH) low-grade gliomas (LGGs) demand a multidisciplinary approach. Individualized management should consider local resources, patient preferences, clinical features, imaging results, and tumor pathological characteristics. We use a multidisciplinary team of neuro-oncologists, medical oncologists, neurosurgeons, radiation oncologists, neuroimaging specialists, geneticists, and neuropathologists collaborated to develop a manuscript through a Delphi consensus method. Diagnosis includes a complete clinical examination, neuroimaging, histopathological tissue examination, and molecular analysis. Treatment options include (a) surgery as the first-line approach, aiming for maximal safe resection; (b) radiation therapy, administered postoperatively or as a primary treatment in selected cases; (c) systemic therapy; and (d) palliative care for patients with advanced disease or limited therapeutic options. For asymptomatic, slow-growing tumors or elderly patients, an appropriate strategy of active surveillance might be considered. We present custom-made diagnostic and therapeutic algorithms for Mexican patients with mIDH-LGG. To optimize treatment outcomes, participation in clinical trials and early referral to specialized centers are encouraged.
Keywords: Isocitrate dehydrogenase. Low-grade glioma. Adult-type diffuse glioma.
