Neurology Journal Club: Characteristics and Outcomes of Patients With IDH-Mutant Grade 2 and 3 Gliomas After Deferred or Adjuvant Radiotherapy

This journal club article reviews the strengths and limitations of a 2025 study by Lanman et al., investigating outcomes-particularly overall survival-in patients with isocitrate dehydrogenase mutant (IDHmt) WHO grade 2 and 3 gliomas who received either adjuvant postsurgical radiotherapy (aXRT) or deferred radiotherapy (dXRT). Despite unclear evidence of survival benefit, current standardized guidelines recommend aXRT-after surgery but before progression-as first-line treatment for high-risk patients defined by higher grade, older age, and subtotal resection. This study demonstrated that although aXRT delayed tumor progression in this cohort, it was associated with worse overall survival. This retrospective, dual-institution analysis highlights a discrepancy between current guidelines and real-world clinical outcomes, emphasizing the need for prospective studies evaluating dXRT in patients with IDH-mutant gliomas.