Identifying clinical risk in low grade gliomas and appropriate treatment strategies, with special emphasis on the role of surgery.

Identifying clinical risk in low grade gliomas and appropriate treatment strategies, with special emphasis on the role of surgery.

Expert Rev Anticancer Ther. 2017 Jun 13;:

Authors: Boissonneau S, Duffau H

Abstract
INTRODUCTION: Diffuse low-grade glioma (DLGG) is a chronic tumoral disease that ineluctably grows, migrates along white matter pathways, and progresses to a higher grade of malignancy. Areas covered: To determine the best individualized treatment attitude for each DLGG patient, and to redefine it over the years, i.e. to optimize the "onco-functional balance" of serial and multimodal therapies, the understanding of the natural history of this chronic disease is crucial but not sufficient. A paradigmatic shift is to tailor the individual management according to the dynamic relationships between DLGG course and neural remodeling. In this spirit, a better knowledge of brain plasticity in a connectomal account of cerebral processing has enabled a dramatic improvement of both oncological and functional outcomes in DLGG patients, by increasing overall survival while preserving (or even improving) the quality of life. Expert Commentary: Here, we propose an individualized and recursive therapeutic strategy in DLGG, leading to the concept of a "personalized functional neuro-oncology", by emphasizing the role of early and maximal safe surgical resection(s) reliably achieved using intraoperative mapping of cortico-subcortical networks in awake patients.

PMID: 28608763 [PubMed - as supplied by publisher]

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