Diffuse low-grade oligodendrogliomas extend beyond MRI-defined abnormalities

Pallud, Johan; Varlet, Pascale; Devaux, Bertrand; Geha, Sameh; Badoual, Mathilde; Deroulers, Christophe; Page, Philippe; Dezamis, Edouard; Daumas-Duport, Cathérine; Roux, François‐Xavier

doi:10.1212/wnl.0b013e3181e04264

Cited by 196 publications

(122 citation statements)

References 39 publications

(37 reference statements)

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“…15) Currently our strategy for oligodendroglioma is gross total resection of the high intensity lesion on T 2 -weighted MR imaging, but more extensive resection may be required to prevent progression of oligodendroglioma. 15) However, concluding that surgical resection does not contribute patient survival would be premature, because patients with oligodendroglioma survive longer and OS may differ after longer follow-up periods. In fact, this study included relatively few death events for patients with oligodendroglioma.…”

Section: Discussionmentioning

confidence: 99%

Updated Therapeutic Strategy for Adult Low-Grade Glioma Stratified by Resection and Tumor Subtype

Nitta

Muragakı

Maruyama

et al. 2013

Neurol. Med. Chir.(Tokyo)

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The importance of surgical resection for patients with supratentorial low-grade glioma (LGG) remains controversial. This retrospective study of patients (n ＝ 153) treated between 2000 to 2010 at a single institution assessed whether increasing the extent of resection (EOR) was associated with improved progression-free survival (PFS) and overall survival (OS). Histological subtypes of World Health Organization grade II tumors were as follows: diffuse astrocytoma in 49 patients (32.0%), oligoastrocytoma in 45 patients (29.4%), and oligodendroglioma in 59 patients (38.6%). Median pre-and postoperative tumor volumes and median EOR were 29.0 cm 3 (range 0.7-162 cm 3 ) and 1.7 cm 3 (range 0-135.7 cm 3 ) and 95%, respectively. Five-and 10-year OS for all LGG patients were 95.1% and 85.4%, respectively. Eight-year OS for diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma were 70.7%, 91.2%, and 98.3%, respectively. Five-year PFS for diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma were 42.6%, 71.3%, and 62.7%, respectively. Patients were divided into two groups by EOR AE90% and º90%, and OS and PFS were analyzed. Both OS and PFS were significantly longer in patients with AE90% EOR. Increased EOR resulted in better PFS for diffuse astrocytoma but not for oligodendroglioma. Multivariate analysis identified age and EOR as parameters significantly associated with OS. The only parameter associated with PFS was EOR. Based on these findings, we established updated therapeutic strategies for LGG. If surgery resulted in EOR º90%, patients with astrocytoma will require second-look surgery, whereas patients with oligodendroglioma or oligoastrocytoma, which are sensitive to chemotherapy, will be treated with chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Updated Therapeutic Strategy for Adult Low-Grade Glioma Stratified by Resection and Tumor Subtype

Nitta

Muragakı

Maruyama

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…74,76 Seizure control is also reported to be improved by total resection, with .90% of patients becoming seizure free or having a significant improvement in seizures following surgery for LGG. 77 Following the demonstration that tumour cells can extend beyond the visible T 2 /fluid attenuation inversion-recovery abnormality on MRI by up to 20 mm 37 and the above findings on the benefit of aggressive extent of resection, some have gone on further to suggest that where possible, "supratotal" resections (resecting beyond the MRI-visible tumour margin) should be attempted and may also reduce the risk of anaplastic progression. 78,79 Maximizing survival chances by attempting the greatest extent of resection possible is obviously important, but only if balanced with no significant detrimental effect on the quality of life following aggressive surgery; after all, the risk of long-term deficit was the initial rationale for surveillance of stable LGG.…”

Section: Emerging Surgical Practicementioning

confidence: 99%

“…83 DTI when compared with intraoperative subcortical language mapping was concordant in 81% of cases, but negative tractography did not rule out the presence of white matter tracks in this area, particularly when invaded by tumour cells. 84 Owing to the infiltrative nature of LGG and the potential for microscopic invasion beyond the visible tumour boundary, 37 it is very unlikely that LGG will be completely resected. Postoperative imaging is therefore also important.…”

Section: Emerging Surgical Practicementioning

confidence: 99%

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‘Low grade glioma’: an update for radiologists

Larsen¹,

Wharton²,

McKevitt³

et al. 2017

The British Journal of Radiology

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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.

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“…10 FLAIR sequences provide the best delineation of WHO grade II glioma, although the exact relation between these sequences and the histologic tumor margin has not been established. 11,12 Volumetric measurements based on FLAIR images are sensitive to subtle volume shrinkage in response to therapy and are promising as a valuable tool for response assessment in LGG.…”

Section: A B C Dmentioning

confidence: 99%