Diffuse low-grade glioma – Changing concepts in diagnosis and management: A review (original) (raw)
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Comprehensive evaluation of treatment and outcomes of low-grade diffuse gliomas
PloS one, 2018
Low-grade gliomas affect younger adults and carry a favorable prognosis. They include a variety of biological features affecting clinical behavior and treatment. Having no guidelines on treatment established, we aim to describe clinical and treatment patterns of low-grade gliomas across the largest cancer database in the United States. We analyzed the National Cancer Database from 2004 to 2015, for adult patients with a diagnosis of World Health Organization grade II diffuse glioma. We analyzed 13,621 cases with median age of 41 years. Over 56% were male, 88.4% were white, 6.1% were black, and 7.6% Hispanic. The most common primary site location was the cerebrum (79.9%). Overall, 72.2% received surgery, 36.0% radiation, and 27.3% chemotherapy. Treatment combinations included surgery only (41.5%), chemotherapy + surgery (6.6%), chemotherapy only (3.1%), radiation + chemotherapy + surgery (10.7%), radiation + surgery (11.5%), radiation only (6.1%), and radiotherapy + chemotherapy (6.7...
Letter to the Editor: Diffuse low-grade gliomas
Journal of Neurosurgery, 2013
Diffuse low-grade gliomas (WHO grade II) are a subgroup of rare and heterogeneous primary brain tumors that usually occur in young patients living a normal life until the onset of a first seizure. A good understanding of the natural history of these gliomas namely: their steady progression, infiltration along white matter fibers and especially the risk of malignant transformation-which endangers the functional and vital prognosis, associated with the minimization of the risk of treatment, has led to a therapeutic change from the "classic" conservative attitude to a more rigorous therapeutic strategy. Current goal is to elaborate dynamic and individualized treatment; that is; to define the sequence and timing of each treatment option (single to multiple safe Copyright © L'encyclopédie neurochirurgicale Diffuse low-grade gliomas maximal surgical resections within cortical-to-sub-cortical functional borders, single to multiple chemotherapy and radiotherapy sessions) depending on tumor progression (measured on regular follow up MRI), clinical and neurocognitive status and individual's functional anatomy of the brain (studied via brain mapping and susceptible to reorganization through the phenomena of neuroplasticity) to prevent malignant transformation as long as possible while preserving the quality of life. Only a multidisciplinary approach to multi-center networks can afford to give a real future to patients with this chronic brain disease, with the possibility to design long-term projects be them socio-professional or at the household level. The next step would be that of early screening in order to provide preventive treatment. L'encyclopédie neurochirurgicale Copyright © L'encyclopédie neurochirurgicale Diffuse low-grade gliomas SUMMARY Diffuse low-grade gliomas (WHO grade II) are a subgroup of rare and heterogeneous primary brain tumors that usually occur in young patients living a normal life until the onset of a first seizure. A good understanding of the natural history of these gliomas namely: their steady progression, infiltration along white matter fibers and especially the risk of malignant transformation-which endangers the functional and vital prognosis, associated with the minimization of the risk of treatment, has led to a therapeutic change from the "classic" conservative attitude to a more rigorous therapeutic strategy. Current goal is to elaborate dynamic and individualized treatment; that is; to define the sequence and timing of each treatment option (single to multiple safe maximal surgical resections within cortical-to-sub-cortical functional borders, single to multiple chemotherapy and radiotherapy sessions) depending on tumor progression (measured on regular follow up MRI), clinical and neurocognitive status and individual's functional anatomy of the brain (studied via brain mapping and susceptible to reorganization through the phenomena of neuroplasticity) to prevent malignant transformation as long as possible while preserving the quality of life. Only a multidisciplinary approach to multi-center networks can afford to give a real future to patients with this chronic brain disease, with the possibility to design long-term projects be them socio-professional or at the household level. The next step would be that of early screening in order to provide preventive treatment.
‘Low grade glioma’: an update for radiologists
The British Journal of Radiology, 2017
With the recent publication of a new World Health Organization brain tumour classification that reflects increased understanding of glioma tumour genetics, there is a need for radiologists to understand the changes and their implications for patient management. There has also been an increasing trend for adopting earlier, more aggressive surgical approaches to low-grade glioma (LGG) treatment. We will summarize these changes, give some context to the increased role of tumour genetics and discuss the associated implications of their adoption for radiologists. We will discuss the earlier and more radical surgical resection of LGG and what it means for patients undergoing imaging.
A Permanent Neurosurgical Challenge: Low Grade Gliomas
Romanian Journal of Neurology
Introduction. The utilization of Magnetic Resonance Spectroscopy (MRS) brings an important piece of information to an overall MR study, thus aiding the physician in making an accurate assumption regarding the histological grade of a tumor. The purpose of this study is to verify the reliability of MRS in correctly diagnosing both the nature of tumors and their grade. Material and methods. This is an observational study that was conducted from January 2011 to June 2016 on 49 patients confirmed to be low-grade gliomas (LGG) by pathological examination, who were admitted in our Neurosurgery Department in this period. Both retrospective and prospective data were collected. Inclusion criteria comprise unique tumoral lesion at the moment of diagnosis, follow-up for at least one year. Exclusion criteria included: other types of tumors with any location, patient refusal to undergo histopathological examination of the resected tissue, uncompliant and non-collaborating patients. Of all patient...
Surgery for Diffuse Low-Grade Gliomas (DLGG) Oncological Outcomes
Diffuse Low-Grade Gliomas in Adults, 2017
For many decades, surgery for DLGG was matter of controversy, mainly due to the fact that, in the classical literature, extent of resection (EOR) was not objectively assessed on post-operative MRI. EOR was usually based on the sole subjectivity of the surgeon, with no volumetric calculation of the residual tumor. In all modern series with objective measurement of the EOR on systematic postoperative T2/FLAIR-weighted MRI, a more aggressive resection predicted significant improvement in overall survival (OS) compared with a simple debulking or biopsyby delaying malignant transformation. However, development of neuroimaging led neurosurgeons to achieve tumorectomy according to the oncological limits provided by preoperative or intraoperative structural and metabolic imaging. Yet, this principle is not coherent, neither with the infiltrative nature of DLGG nor with the limited resolution of current neuroimaging. Indeed, MRI still underestimates the actual spatial extent of gliomas, since tumoral cells are present several millimeters to centimeters beyond the area of signal abnormalities. Therefore, an extended removal of a margin beyond these MRI-defined abnormalities, i.e. a "supra-total" resection, was recently proposed, with a dramatic improvement of OS. Consequently, the actual aim is not to remove only the "top of the iceberg" visible on imaging, but to perform a radical resection of the brain invaded by a DLGG, on the condition that this part of the nervous system is not crucial for cerebral functions. Thus, biopsy should be reserved only in very diffuse lesions, such as gliomatosis-like, when at least a subtotal resection is not possible. Neurosurgeons should shift from a traditional view consisting of removing a tumor mass within the brain (image-guided resection according to oncological and/or anatomical limits) to the removal of a diffuse chronic tumoral disease invading neural networks. They should take the habit to
Advances in the Surgical Management of Low-Grade Glioma
Seminars in Radiation Oncology, 2015
Over the past two decades, extent of resection has emerged as a significant prognostic factor in patients with low-grade gliomas. Greater extent of resection has been shown to improve overall survival, progression-free survival, and time to malignant transformation. The operative goal in the majority of low-grade glioma cases is to maximize extent of resection while avoiding postoperative neurologic deficits. Several advanced surgical techniques have been developed in an attempt to better achieve maximal safe resection. Intraoperative magnetic resonance imaging, fluorescence-guided surgery, intraoperative functional pathway mapping, and neuro-navigation are some of the most commonly utilized techniques with multiple studies to support their efficacy in glioma surgery. By utilizing these techniques either alone or in combination, patients harboring low-grade gliomas have a better prognosis with less surgical morbidity following tumor resection. While recent advances have been made in chemotherapy and radiation therapy for LGG, surgical resection remains essential to its management. A growing body of literature supports the claim that greater extent of resection leads to a significant survival benefit. 8-19 Extent of tumor resection has become a strong predictor of patient outcomes, alongside
Neuro-oncology, 2014
Diffuse low-grade glioma grows, migrates along white matter tracts, and progresses to high-grade glioma. Rather than a "wait and see" policy, an aggressive attitude is now recommended, with early surgery as the first therapy. Intraoperative mapping, with maximal resection according to functional boundaries, is associated with a longer overall survival (OS) while minimizing morbidity. However, most studies have investigated the role of only one specific treatment (surgery, radiotherapy, chemotherapy) without taking a global view of managing the cumulative time while preserving quality of life (QoL) versus time to anaplastic transformation. Our aim is to switch towards a more holistic concept based upon the anticipation of a personalized and long-term multistage therapeutic approach, with online adaptation of the strategy over the years using feedback from clinical, radiological, and histomolecular monitoring. This dynamic strategy challenges the traditional approach by prop...
The dilemma of low grade glioma
Journal of Neurology, Neurosurgery & Psychiatry, 2004
he management of low grade glioma is one of the most controversial areas in clinical neurooncology. There are numerous reviews and editorials outlining the difficulties in management of these lesions. 1-3 Indeed, the pivotal questions about their management remain unanswered. However, the concept of management of low grade gliomas is not unitary but much more a composite of different challenges depending on the clinical presentation, signs, neuroradiology, perspectives of neurologists, the opinion of the neurosurgeon, and perhaps most importantly, the aspirations of the patient. It is true therefore that in many patients there will be a dilemma about what is considered optimal management since there is no good evidence base to underpin any single management undertaken. Conversely, however, there are many groups of patients with various low grade gliomas in whom management decisions are made more easily and pragmatically. In this review, the current approaches to different low grade gliomas presenting with different symptom complexes in different regions of the brain will be reviewed and the rationale for decision making discussed. THE SPECTRUM OF LOW GRADE GLIOMA c Under the recent World Health Organization classification of primary intracranial tumours, low grade gliomas would encompass grade I and grade II neuro-epithelial tumours. The more common grade I tumours are pilocytic astrocytoma, dysembryoblastic neuro-epithelial tumours (DNET), pleomorphic xantho-astrocytoma (PXA), neurocytoma, and ganglioglioma. The more common grade II tumours include astrocytoma, oligodendroglioma, and mixed oligoastrocytoma. This spectrum of discreet neuropathological entities is important since the grade I tumours generally can be cured by surgical excision and their symptoms very often alleviated. 4 Conversely, with the grade II tumours, these are generally incurable but have median survival times of. 5 years. 1-3 Tumours with oligodendodrial components generally do better than astrocytomas, with prognosis being partially related to gene deletions on chromosome 1p and 19q. 5 6 Some grade II gliomas are ''diffuse'' while others have relatively well defined brain-tumour interfaces. Neuropathological diagnosis and tumour characteristics will therefore profoundly influence the impact of treatment strategies. Currently, even with the best magnetic resonance imaging (MRI) scanners, differentiation between grade I, II, and even III tumours is very difficult, therefore establishing tissue diagnosis can be important. 1 7 Adverse prognostic features for patients with low grade glioma c Age. 40 years c Large tumour (. 6 cm) c Midline shift
Dilemma in low-grade glioma surgery: Review of litreture and when to operate
IP Indian Journal of Neurosciences, 2022
Diffuse low-grade gliomas (LGG) are tumours of the glial tissue, which are generally slow-growing, but have the potential to undergo anaplastic progression into more aggressive tumours. Diffuse low-grade gliomas (LGG) represent a heterogeneous group of primary brain tumour arising from supporting glial cells. The role of surgery in the management of human low- gliomas has been controversial. The current adjuvant therapies have facilitated treatment of patients, and have rendered neurosurgical removal without morbidity or mortality more commonplace than ever before. Here, we investigated the role of neurosurgery in the management of adults with low-grade gliomas. The management of low- grade glioma is one of the most controversial areas in clinical neuro-oncology. The concept of management of low-grade gliomas is not unitary but much more a composite of different challenges depending on the clinical presentation, signs, neuroradiology, perspectives of neurologists, the opinion of the...