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Opinion|Videos|May 11, 2026

Institutional Perspectives on Treatment Thresholds in PLGG

Author(s)Mohamed Abdelbaki, MD, Susan N. Chi, MD, Murali Chintagumpala, MD

Experts weigh PLGG treatment choices, balancing chemo and MEK inhibitors, guided by vision decline, symptoms, tumor growth, and family logistics.

Episodes in this series

EP. 1 PLGG as a Chronic Disease

EP. 1 PLGG as a Chronic Disease

EP. 2 PLGG Biology and Targeted Therapy

EP. 2 PLGG Biology and Targeted Therapy

EP. 3 Navigating Treatment Burden and Family Priorities in PLGG

EP. 3 Navigating Treatment Burden and Family Priorities in PLGG

EP. 4 Observation vs. Treatment in PLGG: Functional Outcomes, NF1 Status, and Shared Decision-Making

EP. 4 Observation vs. Treatment in PLGG: Functional Outcomes, NF1 Status, and Shared Decision-Making

EP. 5 MRI Interpretation, Hemorrhage, and Multidisciplinary Monitoring in PLGG

EP. 5 MRI Interpretation, Hemorrhage, and Multidisciplinary Monitoring in PLGG

EP. 6 Treatment Sequencing and Regimen Selection in PLGG

EP. 6 Treatment Sequencing and Regimen Selection in PLGG

EP. 7 Institutional Perspectives on Treatment Thresholds in PLGG

EP. 7 Institutional Perspectives on Treatment Thresholds in PLGG

EP. 8 RAPNO Criteria and MRI Assessment in PLGG: Recommendations vs. Real-World Practice

EP. 8 RAPNO Criteria and MRI Assessment in PLGG: Recommendations vs. Real-World Practice

In this segment, Dr. Abdelbaki and Dr. Margol explore whether specific radiographic or clinical cutoffs should trigger therapy initiation for pediatric low-grade glioma (PLGG).

The experts note that the commonly cited 25% progression threshold can be misleading: in a small tumor, 25% growth is reached quickly and may not be clinically meaningful. Instead, clinical progression—changes in the patient's functional status—is the primary indication to treat. Family dynamics also vary widely: Some families are resistant to starting therapy, while others are anxious and feel reassured by initiating treatment. The decision is ultimately a team discussion in which the family is a central participant, reinforcing that no single metric replaces the holistic assessment of the child.

In the next episode, "RAPNO Criteria and MRI Assessment in PLGG: Recommendations vs. Real-World Practice," the panel discusses how standardized response criteria are applied in routine PLGG care.

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