A Personalized Longitudinal Strategy in Low-Grade Glioma Patients: Predicting Oncological and Neural Interindividual Variability and Its Changes over Years to Think One Step Ahead

Abstract

Diffuse low-grade glioma (LGG) is a rare cerebral cancer, mostly involving young adults with an active life at diagnosis. If left untreated, LGG widely invades the brain and becomes malignant, generating neurological worsening and ultimately death. Early and repeat treatments for this incurable tumor, including maximal connectome-based surgical resection(s) in awake patients, enable postponement of malignant transformation while preserving quality of life owing to constant neural network reconfiguration. Due to considerable interindividual variability in terms of LGG course and consecutive cerebral reorganization, a multistage longitudinal strategy should be tailored accordingly in each patient. It is crucial to predict how the glioma will progress (changes in growth rate and pattern of migration, genetic mutation, etc.) and how the brain will adapt (changes in patterns of spatiotemporal redistribution, possible functional consequences such as epilepsy or cognitive decline, etc.). The goal is to anticipate therapeutic management, remaining one step ahead in order to select the optimal (re-)treatment(s) (some of them possibly kept in reserve), at the appropriate time(s) in the evolution of this chronic disease, before malignization and clinical worsening. Here, predictive tumoral and non-tumoral factors, and their ever-changing interactions, are reviewed to guide individual decisions in advance based on patient-specific markers, for the treatment of LGG.

From molecular signatures to radiomics: tailoring neurooncological strategies through forecasting of glioma growth

“…Forecasting the natural progression of brain tumors, especially within the diverse spectrum of LGGs, stands as a significant challenge in modern neuro-oncology. 1,24 The inherent complexity and pronounced heterogeneity of potential outcomes can inadvertently lead to the adoption of oversimplified treatment paradigms. 1,8 Such methodologies might not only dilute personalized patient care in the pursuit of methodological homogeneity but also precipitate untimely radiotherapy decisions anchored on a narrow spectrum of molecular markers that may provide limited value on an individual level.…”

“…1,24 The inherent complexity and pronounced heterogeneity of potential outcomes can inadvertently lead to the adoption of oversimplified treatment paradigms. 1,8 Such methodologies might not only dilute personalized patient care in the pursuit of methodological homogeneity but also precipitate untimely radiotherapy decisions anchored on a narrow spectrum of molecular markers that may provide limited value on an individual level. 7 In this investigation, we aimed to overcome these limitations by harnessing a comprehensive dataset, integrating detailed anatomical information and precise and quantifiable resection metrics.…”

“…The inherent heterogeneity of LGGs, only superficially addressed by current pathological and molecular analyses, underscores the imperative need for more refined and patient-centric management strategies. 1,2 Given the extended survival typically associated with LGGs, the primary objective has transcended mere life extension to encompass the assurance of optimal quality of life. This necessitates a consideration wherein repeated surgeries are more advantageous than early radiotherapy, which is known to potentially impair cognitive functions over time.…”