Low-Grade Glioma Case Series: Lessons Learned from an Evolving 10-Year Single-Institution Multidisciplinary Team Practice

Acharya, Siddharth; Lavrador, José Pedro; Sekhon, Priya; Visagan, Ravindran; Jung, Josephine; Gullan, Richard; Vergani, Francesco; Bhangoo, Ranjeev; Ashkan, Keyoumars

doi:10.1016/j.wneu.2021.03.101

Cited by 3 publications

(4 citation statements)

References 34 publications

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“…In spite of the latest Cochrane review (2017) on biopsy versus resection for low-grade gliomas, stating that there are no randomized controlled trials to determine the best surgical choice [56], numerous systematic reviews and meta-analysis confirm a positive correlation between EOR and overall survival (OS) in DLGG [22,[57][58][59], along with some of the most recently published single-institution experiences [60][61][62][63][64]. The longer OS achieved is related to a change in the natural history of the disease, surgery allowing us to significantly reduce the risk of malignant transformation, thanks to a decrease in the number of tumor cells.…”

Section: Ptz Recognition Supports Supratotal Resection and Vice Versamentioning

confidence: 99%

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

2022

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Diffuse low-grade gliomas (DLGGs) are heterogeneous and poorly circumscribed neoplasms with isolated tumor cells that extend beyond the margins of the lesion depicted on MRI. Efforts to demarcate the glioma core from the surrounding healthy brain led us to define an intermediate region, the so-called peritumoral zone (PTZ). Although most studies about PTZ have been conducted on high-grade gliomas, the purpose here is to review the cellular, metabolic, and radiological characteristics of PTZ in the specific context of DLGG. A better delineation of PTZ, in which glioma cells and neural tissue strongly interact, may open new therapeutic avenues to optimize both functional and oncological results. First, a connectome-based “supratotal” surgical resection (i.e., with the removal of PTZ in addition to the tumor core) resulted in prolonged survival by limiting the risk of malignant transformation, while improving the quality of life, thanks to a better control of seizures. Second, the timing and order of (neo)adjuvant medical treatments can be modulated according to the pattern of peritumoral infiltration. Third, the development of new drugs specifically targeting the PTZ could be considered from an oncological (such as immunotherapy) and epileptological perspective. Further multimodal investigations of PTZ are needed to maximize long-term outcomes in DLGG patients.

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Section: Ptz Recognition Supports Supratotal Resection and Vice Versamentioning

confidence: 99%

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

2022

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“…Previous findings suggest that patients older than 40 years have a significantly higher risk of recurrence or death after surgery ( 17 , 18 ). Our results, that age beyond 45 years, were associated with an increased risk of postoperative recurrence of gliomas, were largely consistent with previous studies.…”

Section: Discussionmentioning

confidence: 98%

Predictors of tumor progression of low-grade glioma in adult patients within 5 years follow-up after surgery

et al. 2022

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BackgroundGlioma originates from glial cells in the brain and is the most common primary intracranial tumor. This study intends to use a retrospective analysis to explore the factors that can predict tumor progression in adult low-grade gliomas, namely WHO II grade patients, within 5 years after surgery.MethodsPatients with WHO grade II glioma who were surgically treated in our hospital from February 2011 to May 2017 were included. According to the inclusion and exclusion criteria, 252 patients were included in the final analysis. According to the results of the 5-year follow-up (including survival and imaging review results), patients were divided into progression-free group and progression group. Univariate and multivariate analysis were conducted to investigate the related factors of tumor progression during the 5-year follow-up.ResultsThe results of the 5-year follow-up showed that 111 (44.0%) cases had no progress (progression free group, PFG), 141 (56.0%) cases had progress (progression group, PG), of which 43 (30.5%) cases were operated again, 37 cases (26.2%) received non-surgical treatments. There were 26 (10.3%) all-cause deaths, and 21 (8.3%) tumor-related deaths. Univariate and multivariate analysis showed that age >45 years old (OR = 1.35, 95% CI, 1.07–3.19, P = 0.027), partial tumor resection (OR = 1.66, 95% CI, 1.15–3.64, P = 0.031), tumor diameter >3 cm (OR = 1.52, 95% CI, 1.14–4.06, P = 0.017) and no radiotherapy (OR = 1.37, 95% CI, 1.12–2.44, P = 0.039) were independent predictors of the progression of tumor during the 5-year follow-up period.ConclusionAge >45 years old, partial tumor resection, tumor diameter >3 cm, no radiotherapy are predictors for tumor progression for glioma patients after surgery.

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“…Epileptic seizures were the first symptom of LGG in over 70% of cases [ 21 ]. The most common manifestations were found when the tumor lesion was in the frontal lobe [ 22 , 23 , 24 ]. This aspect was also found in our cases, the tumor localization at the level of the frontal lobe or in contact with it most frequently generated epileptic seizures.…”

Section: Discussionmentioning

confidence: 99%

“…This also has the role of providing tumor boundaries and tumor volume [ 30 ]. Most LGGs are supratentorial, having no predilection for the hemisphere, whereas the most common location is in the frontal lobe [ 3 , 22 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Low-Grade Gliomas in Adults

et al. 2022

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Adult low-grade gliomas are a rare and aggressive pathology of the central nervous system. Some of their characteristics contribute to the patient’s life expectancy and to their management. This study aimed to characterize and identify the main prognostic factors of low-grade gliomas. The six-year retrospective study statistically analyzed the demographic, imaging, and morphogenetic characteristics of the patient group through appropriate parameters. Immunohistochemical tests were performed: IDH1, Ki-67, p53, and Nestin, as well as FISH tests on the CDKN2A gene and 1p/19q codeletion. The pathology was prevalent in females, with patients having an average age of 56.31 years. The average tumor volume was 41.61 cm3, producing a midline shift with an average of 7.5 mm. Its displacement had a negative impact on survival. The presence of a residual tumor resulted in decreased survival and is an independent risk factor for mortality. Positivity for p53 identified a low survival rate. CDKN2A mutations were an independent risk factor for mortality. We identified that a negative prognosis is influenced by the association of epilepsy with headache, tumor volume, and immunoreactivity to IDH1 and p53. Independent factors associated with mortality were midline shift, presence of tumor residue, and CDKN2A gene deletions and amplifications.

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Low-Grade Glioma Case Series: Lessons Learned from an Evolving 10-Year Single-Institution Multidisciplinary Team Practice

Cited by 3 publications

References 34 publications

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude

Predictors of tumor progression of low-grade glioma in adult patients within 5 years follow-up after surgery

Prognostic Factors of Low-Grade Gliomas in Adults

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