Place de la radiochirurgie dans le traitement des oligodendrogliomes

Radiosurgery of oligodendrogliomas is not specific. It must be integrated into the overall treatment scheme for gliomas which remains to be strictly defined. Nevertheless, empirically, and in light of the limited constraints for the patient and the encouraging radiological and clinical benefits, radiosurgical teams usually propose this technique in the event of recurrence of malignant gliomas, as a second line treatment. Exceptionally radiation can be used for some small benign gliomas which could not be treated by open surgery and accurately defined radiologically. Radiosurgery can achieve local control of the lesion, mostly transitionally, with 15 to 18 Gy at the reference isodose. One of the key problems is the definition of the glioma boundaries. Despite progress in neuroimaging techniques most the limits of malignant forms are still not accessible. In routine practice, the nodular area, considered as the most active on MRI, i.e. the contrast enhanced area, is accepted as the target. Its widest dimension must be about 35-40 mm. Only patients with minimal disability can benefit from radiosurgery. Optimization of the target definition (in particular the most active zone) and prospective randomized studies should be helpful in clarifying indications for this technique.