New Individualized Strategies in DLGG

Chapter

Abstract

Although diffuse low-grade glioma (DLGG) is a chronic disease of the brain, the vast majority of studies investigated the role of only one specific treatment (e.g., impact of surgery, or impact of radiotherapy, or impact of chemotherapy) without a global view of the whole management. Here, our aim is to switch toward a more holistic concept, based on the anticipation of a personalized and long-term multistage therapeutic approach, with online adaptation of the strategy over years through the feedback provided by clinical, radiological, and pathologico-molecular monitoring at the individual scale. Indeed, we need to elaborate and then to adjust this tailored management during the follow-up, both on the basis of real-time oncological result (control of the glioma) as well as on the basis of functional outcome (preservation or even improvement of quality of life). Thus, we propose new individualized strategies dealing with the chronic interactions between the natural course of the DLGG, the reactional brain plasticity, and the onco-functional modulation elicited by serial treatments.

Keywords

Diffuse low-grade glioma Surgery Chemotherapy Radiotherapy Individualized management Multistage therapeutic approach Quality of life 

References

  1. 1.
    Mandonnnet E, Duffau H, Bauchet L. A new tool for grade II glioma studies: plotting cumulative time with quality of life versus time to malignant transformation. J Neurooncol. 2012;106:213–5.CrossRefGoogle Scholar
  2. 2.
    Duffau H. A new concept of diffuse (low-grade) glioma surgery. Adv Tech Stand Neurosurg. 2012;38:3–27.PubMedCrossRefGoogle Scholar
  3. 3.
    Pallud J, Taillandier L, Capelle L, Fontaine D, Peyre M, Ducray F, et al. Quantitative morphological MRI follow-up of low-grade glioma: a plead for systematic measurement of growth rates. Neurosurgery. 2012;31:729–39.CrossRefGoogle Scholar
  4. 4.
    Klein M, Duffau H, De Witt Hamer PC. Cognition and resective surgery for diffuse infiltrative glioma: an overview. J Neurooncol. 2012;108:309–18.PubMedCrossRefGoogle Scholar
  5. 5.
    Ruge MI, Ilmberger J, Tonn JG, Kreth FW. Health-related quality of life and cognitive functioning in adult patients with supratentorial WHO grade II glioma: status prior to therapy. J Neurooncol. 2011;103:129–36.PubMedCrossRefGoogle Scholar
  6. 6.
    Soffietti R, Baumert B, Bello L, von Deimling A, Duffau H, Frénay M, et al. Guidelines on management of low grade gliomas: report of an EFNS-EANO task force. Eur J Neurol. 2010;17:1124–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Duffau H. Surgery of low-grade gliomas: towards a “functional neurooncology”. Curr Opin Oncol. 2009;21:543–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26:1338–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Chang EF, Clark A, Smith JS, Polley MY, Chang SM, Barbaro NM, et al. Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long term survival. J Neurosurg. 2011;114:566–73.PubMedCrossRefGoogle Scholar
  10. 10.
    De Witt Hamer PC, Gil Robles S, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2559–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Duffau H. The challenge to remove diffuse low-grade gliomas while preserving brain functions. Acta Neurochir (Wien). 2012;154:569–74.CrossRefGoogle Scholar
  12. 12.
    Yordanova Y, Moritz-Gasser S, Duffau H. Awake surgery for WHO grade II gliomas within “noneloquent” areas in the left dominant hemisphere: toward a “supratotal” resection. J Neurosurg. 2011;115:232–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Mandonnet E, Pallud J, Clatz O, Taillandier L, Konukoglu E, Duffau H, et al. Computational modeling of the WHO grade II glioma dynamics: principles and applications to management paradigm. Neurosurg Rev. 2008;31:263–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Martino J, Taillandier L, Moritz-Gasser S, Gatignol P, Duffau H. Re-operation is a safe and effective therapeutic strategy in recurrent WHO grade II gliomas within eloquent areas. Acta Neurochir (Wien). 2009;151:427–36.CrossRefGoogle Scholar
  15. 15.
    Duffau H. Brain plasticity: from pathophysiological mechanisms to therapeutic applications. J Clin Neurosci. 2006;13:885–97.PubMedCrossRefGoogle Scholar
  16. 16.
    Duffau H. Brain plasticity and tumors. Adv Tech Stand Neurosurg. 2008;33:3–33.PubMedCrossRefGoogle Scholar
  17. 17.
    Gil Robles S, Gatignol P, Lehéricy S, Duffau H. Long-term brain plasticity allowing multiple-stages surgical approach for WHO grade II gliomas in eloquent areas: a combined study using longitudinal functional MRI and intraoperative electrical stimulation. J Neurosurg. 2008;109:615–24.CrossRefGoogle Scholar
  18. 18.
    Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, van Effenterre R, et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry. 2005;76:845–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Ius T, Angelini E, de Schotten MT, Mandonnet E, Duffau H. Evidence for potentials and limitations of brain plasticity using an atlas of functional respectability of WHO grade II gliomas: towards a “minimal common brain”. Neuroimage. 2011;56:992–1000.PubMedCrossRefGoogle Scholar
  20. 20.
    Mandonnet E, Jbabdi S, Taillandier L, Galanaud D, Benali H, Capelle L, et al. Preoperative estimation of residual volume for WHO grade II glioma resected with intraoperative functional mapping. Neuro Oncol. 2007;9:63–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Ghareeb F, Duffau H. Intractable epilepsy in paralimbic Word Health Organization Grade II gliomas: should the hippocampus be resected when not invaded by the tumor? J Neurosurg. 2012;116(6):1226–34.PubMedCrossRefGoogle Scholar
  22. 22.
    Blonski M, Taillandier L, Herbet G, Maldonado IL, Beauchesne P, Fabbro M, et al. Combination of neoadjuvant chemotherapy followed by surgical resection as new strategy for WHO grade II gliomas: a study of cognitive status and quality of life. J Neurooncol. 2012;106:353–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Taillandier L, Duffau H. Epilepsy and insular grade II gliomas: an interdisciplinary point of view from a retrospective monocentric series of 46 cases. Neurosurg Focus. 2009;27:E8.PubMedCrossRefGoogle Scholar
  24. 24.
    Peyre M, Cartalat-Carel S, Meyronet D, Ricard D, Jouvet A, Pallud J, et al. Prolonged response without prolonged chemotherapy: a lesson from PCV chemotherapy in low-grade gliomas. Neuro Oncol. 2010;12:1078–82.PubMedCrossRefGoogle Scholar
  25. 25.
    Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E, et al. Dynamic history of low-grade gliomas before and after temozolomide treatment. Ann Neurol. 2007;61:484–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Pallud J, Mandonnet E, Duffau H, Kujas M, Guillevin R, Galanaud D, et al. Prognostic value of initial magnetic resonance imaging growth rates for World Health Organization grade II gliomas. Ann Neurol. 2006;60:380–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Guillevin R, Menuel C, Taillibert S, Capelle L, Costalat R, Abud L, et al. Predicting the outcome of grade II glioma treated with temozolomide using proton magnetic resonance spectroscopy. Br J Cancer. 2011;104:1854–61.PubMedCrossRefGoogle Scholar
  28. 28.
    van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, et al. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet. 2005;366:985–90.PubMedCrossRefGoogle Scholar
  29. 29.
    Douw L, Klein M, Fagel SS, van den Heuvel J, Taphoorn MJ, Aaronson NK, Postma TJ, et al. Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up. Lancet Neurol. 2009;8:810–8.PubMedCrossRefGoogle Scholar
  30. 30.
    van den Bent MJ, Wefel JS, Schiff D, Taphoorn MJ, Jaeckle K, Junck L, et al. Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas. Lancet Oncol. 2011;12:583–93.PubMedCrossRefGoogle Scholar
  31. 31.
    Mandonnet E, Capelle L, Duffau H. Extension of paralimbic low-grade gliomas: toward an anatomical classification based on white matter invasion patterns. J Neurooncol. 2006;78:179–85.PubMedCrossRefGoogle Scholar
  32. 32.
    Provenzale JM, Mancini MC. Assessment of intra-observer variability in measurement of high-grade brain tumors. J Neurooncol. 2012;108:477–83.PubMedCrossRefGoogle Scholar
  33. 33.
    Soffietti R, Borgognone M, Ducati A, Ricardi U, Ruda’ R. Efficacy of radiation therapy on seizures in low-grade astrocytomas. Neuro Oncol 2005;7:389 (suppl. World Congress of Neuro-Oncology, Edinburgh, 2005).Google Scholar
  34. 34.
    Pallud J, Llitjos JF, Dhermain F, Varlet P, Dezamis E, Devaux B, et al. Dynamic imaging response following radiation therapy predicts long-term outcomes for ­diffuse low-grade gliomas. Neuro Oncol. 2012;14:496–505.PubMedCrossRefGoogle Scholar
  35. 35.
    Monje ML, Mizumatsu S, Fike JR, Palmer TD. Irradiation induces neural precursor-cell dysfunction. Nat Med. 2002;8:955–62.PubMedCrossRefGoogle Scholar
  36. 36.
    Osato K, Sato Y, Ochiishi T, Osato A, Zhu C, Sato M, et al. Apoptosis-inducing factor deficiency decreases the proliferation rate and protects the subventricular zone against ionizing radiation. Cell Death Dis. 2010;1:e84.PubMedCrossRefGoogle Scholar
  37. 37.
    Park KJ, Kano H, Kondziolka D, Niranjan A, Flickinger JC, Lunsford LD. Early or delayed radiosurgery for WHO grade II astrocytomas. J Neurooncol. 2011;103:523–32.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Neurosurgery, Gui de Chauliac HospitalMontpellier University Medical CenterMontpellier Cedex 5France
  2. 2.National Institute for Health and Medical Research (INSERM), U1051 Laboratory, Team “Brain Plasticity, Stem Cells and Glial Tumors”, Institute for Neurosciences of MontpellierMontpellier University Medical CenterMontpellierFrance
  3. 3.Neurooncology Unit, Department of NeurologyUniversity Hospital – Hôpital CentralCedex NancyFrance
  4. 4.Centre de recherche en Automatique (CRAN), Département Santé-Biologie-Signal (SBS)Université de LorraineNancyFrance

Personalised recommendations