Unlocking new horizons: advances in treating IDH-mutant, 1p/19q-codeleted oligodendrogliomas.

Oligodendrogliomas are a distinct subtype of diffuse gliomas characterized by IDH mutations and 1p/19q codeletion, classified as grade 2 or 3 based on histological features. This review examines current advancements in the diagnosis, treatment, and prognosis of oligodendrogliomas, with an emphasis on personalized approaches driven by molecular insights. Surgery remains the cornerstone of treatment, aiming for maximal safe resection to obtain tissue for diagnosis and alleviate symptoms. For grade 2 tumors with residual disease but no symptomatic progression, the IDH inhibitor vorasidenib has emerged as a promising option to delay the need for radiation therapy (RT) and chemotherapy. For grade III oligodendrogliomas, postoperative combined-modality therapy with RT and chemotherapy, such as the PCV regimen, demonstrates significant survival benefits, while temozolomide is an alternative due to its ease of administration and reduced toxicity. Recurrent oligodendrogliomas present therapeutic challenges, necessitating tailored strategies based on prior treatments and the interval since initial therapy. Options include repeat surgery, reirradiation, or novel targeted therapies. Advances in molecular diagnostics, such as homozygous CDKN2A/B deletion as a prognostic marker, have refined risk stratification and informed treatment decisions. Despite these strides, further research is needed to optimize long-term outcomes and address resistance mechanisms. This review underscores the importance of integrating molecular diagnostics with clinical management to achieve personalized, evidence-based care for patients with oligodendrogliomas.