Variations in the management of diffuse low-grade gliomas—A Scandinavian multicenter study

Munkvold, Bodil Karoline Ravn; Solheim, Ole; Bártek, Jiří; Corell, Alba; Dios, Eddie de; Gulati, Sasha; Helseth, Eirik; Holmgren, Klas; Jensdottir, Margret; M, Lundborg; Mireles, Eduardo Erasmo Mendoza; Mahesparan, Ruby; Tveiten, Øystein Vesterli; Milos, Peter; Redebrandt, Henrietta Nittby; Pedersen, Lars Kjelsberg; Ramm‐Pettersen, Jon; Sjöberg, Rickard L.; Sjögren, Björn; Sjåvik, Kristin; Smits, Anja; Tomasevic, Gregor; Vecchio, Tomás Gómez; Vik-Mo, Einar O.; Zetterling, Maria; Salvesen, Øyvind; Jakola, Asgeir Store

doi:10.1093/nop/npab054

Cited by 5 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The demographics of the study cohort together with the variables associated with presence of complications following glioma surgery were comparable with previous reports on patients with dLGG (28)(29)(30)(31)(32), indicating that our results hold high external validity. There are, however, limitations inherent to the retrospective design of our study.…”

Section: Strengths and Limitationssupporting

confidence: 86%

Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundRecently, the Therapy-Disability-Neurology (TDN) was introduced as a multidimensional reporting system to detect adverse events in neurosurgery. The aim of this study was to compare the novel TDN score with the Landriel–Ibanez classification (LIC) grade in a large cohort of patients with diffuse lower-grade glioma (dLGG). Since the TDN score lacks validation against patient-reported outcomes, we described health-related quality of life (HRQoL) change in relation to TDN scores in a subset of patients.MethodsWe screened adult patients with a surgically treated dLGG World Health Organization (WHO) grade 2 and 3 between 2010 and 2020. Up until 2017, it consists of a retrospective cohort (n = 158). From 2017 and onwards, HRQoL was registered using EuroQoL-5-dimension, three levels of response (EQ-5D 3L) questionnaire at baseline and 3 months follow-up, in a prospectively recruited cohort (n = 102). Both the LIC grade and TDN score were used to classify adverse events.ResultsIn total, 231 patients were included. In 110/231 (47.6%) of the surgical procedures, a postoperative complication was registered. When comparing the TDN score to LIC grades, only a minor shift towards complications of higher order could be observed. EQ-5D 3L was reported for 45 patients. Patients with complications related to surgery had pre- to postoperative changes in EQ-5D 3L index values (n = 27; mean 0.03, 95% CI −0.06 to 0.11) that were comparable to patients without complications (n = 18; mean −0.06, 95% CI −0.21 to 0.08). In contrast, patients with new-onset neurological deficit had a deterioration in HRQoL at follow-up, with a mean change in the EQ-5D 3L index value of 0.11 (n = 13, 95% CI 0.0 to 0.22) compared to −0.06 (n = 32, 95% CI −0.15 to 0.03) for all other patients.ConclusionsIn patients with dLGG, TDN scores compared to the standard LIC tend to capture more adverse events of higher order. There was no clear relation between TDN severity and HRQoL. However, new-onset neurological deficit caused impairment in HRQoL. For the TDN score to better align with patient-reported outcomes, more emphasis on neurological deficit and function should be considered.

show abstract

Section: Strengths and Limitationssupporting

confidence: 86%

Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Surprisingly, even though only eloquent lesions were selected in our series in 20% of cases no use of IoM was reported which may bias our results. The prevalence of IoM in our series is higher than in the above cited contemporary study by Munkvold et al ( 26 ) (76% vs. 58%). Given that only eloquent lesions were approached, from our point of view all patients should be operated using IoM.…”

Section: Discussioncontrasting

confidence: 73%

“…This correlates with the current German management guidelines for glioma ( 27 ). Our data shows a slightly lower but relatively similar number of watch and scan than a current large Scandinavian series with 17% of patients ( 26 ). The authors have not provided the outcome data of these patients, so far.…”

Section: Discussioncontrasting

confidence: 54%

Eloquent Lower Grade Gliomas, a Highly Vulnerable Cohort: Assessment of Patients’ Functional Outcome After Surgery Based on the LoG-Glio Registry

et al. 2022

View full text Add to dashboard Cite

Majority of lower grade glioma (LGG) are located eloquently rendering surgical resection challenging. Aim of our study was to assess rate of permanent deficits and its predisposing risk factors. We retrieved 83 patients harboring an eloquently located LGGs from the prospective LoG-Glio Database. Patients without surgery or incomplete postoperative data were excluded. Sign rank test, explorative correlations by Spearman ρ and multivariable regression for new postoperative deficits were calculated. Eloquent region involved predominantly motor (45%) and language (40%). At first follow up after 3 months permanent neuro-logical deficits (NDs) were noted in 39%. Mild deficits remained in 29% and severe deficits in 10%. Complete tumor removal (CTR) was successfully in 62% of intended cases. Postoperative and 3-month follow up National Institute of Health Stroke Score (NIHSS) showed significantly lower values than preoperatively (p<0.001). 38% cases showed a decreased NIHSS at 3-month, while occurrence was only 14% at 9-12-month follow up. 6/7 patients with mild aphasia recovered after 9-12 months, while motor deficits present at 3-month follow up were persistent in majority of patients. Eastern oncology group functional status (ECOG) significantly decreased by surgery (p < 0.001) in 31% of cases. Between 3-month and 9-12-months follow up no significant improvement was seen. In the multivariable model CTR (p=0.019, OR 31.9), and ECOG>0 (p=0.021, OR 8.5) were independent predictors for permanent postoperative deficit according to NIHSS at 3-month according to multivariable regression model. Patients harboring eloquently located LGG are highly vulnerable for permanent deficits. Almost one third of patients have a permanent reduction of their functional status based on ECOG. Risk of an extended resection has to be balanced with the respective oncological benefit. Especially, patients with impaired pre-operative status are at risk for new permanent deficits. There is a relevant improvement of neurological symptoms in the first year after surgery, especially for patients with slight aphasia.

show abstract

“…A 2020 literature review on the use of CT alone found lower rates of disease progression under TMZ (4%-5%) when compared with PCV (11%-18%) [71]. Nonetheless, there is no consensus when choosing a reference treatment [70,72]. Regarding radiotherapy (RT), despite its impact on glioma, there is growing evidence that it may increase the risk of neurocognitive side effects in the long term [73].…”

Section: Ptz Influence On (Neo)adjuvant Treatmentmentioning

confidence: 99%

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

2022

View full text Add to dashboard Cite

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.

show abstract

Variations in the management of diffuse low-grade gliomas—A Scandinavian multicenter study

Cited by 5 publications

References 31 publications

Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas

Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas

Eloquent Lower Grade Gliomas, a Highly Vulnerable Cohort: Assessment of Patients’ Functional Outcome After Surgery Based on the LoG-Glio Registry

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

Contact Info

Product

Resources

About