Overview of treatment of grade 2 astrocytomas

Grade 2 astrocytomas are slow-growing brain tumors, most common in young patients and often presenting with seizures.In 2016, the World Health Organization (WHO) updated its classification to include molecular features to better assess tumor behavior.After gross tumor resection, based on a risk-adapted approach, a watch-and-wait strategy, radiotherapy followed by chemotherapy, or IDH-targeted therapy may be applied.For adjuvant treatment, radiotherapy remains a key component, followed by chemotherapy regimens such as PCV or temozolomide, depending on patient tolerance.Advances in pharmacotherapy, including IDH inhibitors, show promise in delaying disease progression with favorable safety profiles, though their impact on overall survival and long-term toxicity remains uncertain.Immunotherapy and vaccine-based approaches are under investigation but are limited by the bloodbrain barrier.Long-term MRI monitoring is essential during and after adjuvant therapy.Future treatment strategies are expected to incorporate molecular-targeted agents and more advanced radiotherapy and surgical techniques to improve outcomes and preserve quality of life.This paper reviews current and emerging treatments for grade 2 astrocytomas to support clinical decision-making.With the recent European Medicines Agency approval of IDH inhibitors, major therapeutic changes are anticipated, supported by ongoing evaluation of efficacy and safety in practice.