Management of supratentorial recurrent low-grade glioma: A multidisciplinary experience in 35 adult patients

Abstract

The management of recurrent diffuse low-grade gliomas (LGGs) is controversial. In the present study, the multidisciplinary management of 35 patients with recurrent LGGs was retrospectively analyzed. Tumor progression or recurrence was defined by clinical, radiological and/or metabolic pejorative evolution. All patients were regularly followed up by a multidisciplinary neuro-oncological group at Hôpital Erasme. Patients with histologically confirmed supratentorial LGGs (7 astrocytoma, 22 oligodendrogliomas and 6 oligoastrocytomas) who had undergone surgery between August 2004 and November 2010 were included. A total of 3 patients exhibited no tumor progression (median follow-up (FU), 81 months; range, 68–108 months). Tumor recurrence occurred in the 32 remaining patients [progression-free survival (PFS), 26 months; range, 2–104 months]. In addition, 25/29 (86%) patients who received surgery alone underwent reoperation at the time of tumor recurrence, and high-grade transformation occurred in 6 of these patients (24%). Furthermore, 4/29 (14%) patients were treated with adjuvant therapy alone (3 chemotherapy and 1 radiotherapy). In the 19 patients with no high-grade transformation at reintervention, 3 received adjuvant therapy and 16 were regularly followed up through multimodal imaging. The PFS time of the patients who underwent reoperation with close FU (n=16) and for the patients receiving adjuvant therapy with or without surgery (n=7) at first recurrence was 10 and 24 months (P=0.005), respectively. However, no significant difference was observed for overall survival (P=0.403). At the time of this study, 22 of the 35 patients included were alive following a median FU time of 109 months (range, 55–136). The results of the present study could change the multidisciplinary approach used into a more aggressive approach with adjuvant therapy, with or without surgery, for the treatment of a select subpopulation of patients with LGGs at the first instance of tumor recurrence.

Repeated Awake Surgical Resection(s) for Recurrent Diffuse Low-Grade Gliomas: Why, When, and How to Reoperate?

“…( 35 ), the median time to transformation was significantly prolonged after reoperation (14.4 years) compared with a control group without the second surgery (3.5 years, p = 0.0002) ( 38 ). However, the rate of MT histologically confirmed at reoperation is high, i.e., in a range between 19% and 74% in the literature ( 24 – 26 , 31 , 35 , 36 , 39 ), with a lesser EOR ( 37 ) and a decreased OS when reoperation is performed after tumor transformation ( 28 ).…”

“…( 25 ); 62% of patients still alive following a median FU of 109 months in the study of Spitaels et al. ( 31 ); 92% of patients still alive at 5 years in the study of Capo et al. ( 36 ); and 93.5% still alive after an overall FU of 8.3 years in the study of Ng et al.…”

“…From an oncological perspective, the median survival was not yet reached at the last FU in several cohorts: no death with a median FU from initial diagnosis at 6.6 years in the study of Martino et al (25); 62% of patients still alive following a median FU of 109 months in the study of Spitaels et al (31); 92% of patients still alive at 5 years in the study of Capo et al (36); and 93.5% still alive after an overall FU of 8.3 years in the study of Ng et al (38). In studies with enough FU to report survival, the OS was 12.95 years in the study of Ramakrishna et al (28) and 14.8 years in the study of Shofty et al (35), namely, significantly longer in comparison with an OS of only 6.5 years in a control group of patients who experienced DLGG progression or transformation but who did not undergo a second surgery (p = 0.0001) (35).…”

Factors Related to the Recurrence of Low-grade Gliomas

“…3 The adjuvant treatment with chemotherapy and radiotherapy can be indicated in cases of recurrence of low-grade gliomas submitted to a second surgery or not. 4…”

“…3 The adjuvant treatment with chemotherapy and radiotherapy can be indicated in cases of recurrence of low-grade gliomas submitted to a second surgery or not. 4 For some authors, 5 reoperation for recurrent low-grade glioma is strongly indicated and should be as radical as possible. For others, 6 there is no strong evidence to recommend reoperation, and further clinical studies on the subject are required.…”