What is the place of conservative management for adult supratentorial low-grade glioma?
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Adult supratentorial low-grade gliomas (LGG) cover a spectrum of neuropathologies that invariably present with seizure disorders. Following neuroradiological diagnosis management strategy will be determined by prognostic indicators such as patient age, lesion size, lesion location, clinical performance status and radiological differential diagnosis. Conservative management, characterised by a “watch and wait” policy, with serial neuroimaging and clinical observation, may form an integral part of overall Multi-Disciplinary Team management strategy in many patients. Conservative management may include the periods following radiological diagnosis to primary surgery, and from the time of surgery to timing of radiotherapy or chemotherapy. Results from randomised controlled clinical trials in LGG, recent findings following microsurgical excision, findings from serial observations using volumetric MRI, and recent findings following chemotherapy and tumour genotyping have helped in defining the place of conservative management in individual cases. These recent findings have moved conservative management from a ‘controversial’ legacy of a bygone era to a more objectively based coherent management component that is understood by both medical and surgical neuro-oncologists. However there is still no evidence from randomised controlled trials to either support or indict the role of conservative management, prior to primary intervention, in LGG. Informing patients of the uncertainties in both interventional strategies and the place of conservative management in LGG is essential in optimising patient outcomes and satisfaction.
KeywordsLow-grade glioma astrocytoma oligodendroglioma MRI clinical trials watch and wait
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- 4.Chaichana KL, McGirt MJ, Niranjan A, Olivi A, Burger PC, Quinones-Hinojosa A (2009) Prognostic significance of contrast-enhancing low-grade gliomas in adults and a review of the literature. Neurol Res [Epub ahead of print]Google Scholar
- 7.Duffau H (2006) Management of low-grade gliomas. Rev Prat [Article in French] 56(16): 1771–77Google Scholar
- 8.Duffau H, Capelle L, Denvil D, Sichez N, Gatignol P, Lopes M, Mitchell MC, Sichez JP, Van Effenterre R (2003) Functional recovery after surgical resection of low-grade gliomas in eloquent brain: hypothesis of brain compensation. J Neurol Neurosurg Psychiatry 74(7): 901–07CrossRefPubMedGoogle Scholar
- 9.Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, Van Effenterre R, Capelle L (2005) 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 76(6): 845–51CrossRefPubMedGoogle Scholar
- 12.Guillevin R, Menuel C, Duffau H, Kujas M, Capelle L, Aubert A, Taillibert S, Idbaih A, Pallud J, Demarco G, Costalat R, Hoang-Xuan K, Chiras J, Vallèe JN (2008) Proton magnetic resonance spectroscopy predicts proliferative activity in diffuse low-grade gliomas. J Neurooncol 87(2): 181–87CrossRefPubMedGoogle Scholar
- 13.Hoang-Xuan K, Capelle L, Kujas M, Taillibert S, Duffau H, Lejeune J, Polivka M, Crinière E, Marie Y, Mokhtari K, Carpentier AF, Laigle F, Simon JM, Cornu P, Broët P, Sanson M, Delattre JY (2004) Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions. J Clin Oncol 22(15): 3133–38CrossRefPubMedGoogle Scholar
- 16.Karim AB, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O, Darcel F, Stenning S, Pierart M, Van Glabbeke M (2002) Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study (22845) with the Medical Research Council study BRO4: an interim analysis. Int J Radiat Oncol Biol Phys 52(2): 316–24PubMedGoogle Scholar
- 19.Kujas M, Lejeune J, Benouaich-Amiel A, Crinière E, Laigle-Donadey F, Marie Y, Mokhtari K, Polivka M, Bernier M, Chretien F, Couvelard A, Capelle L, Duffau H, Cornu P, Broët P, Thillet J, Carpentier AF, Sanson M, Hoang-Xuan K, Delattre JY (2005) Chromosome 1p loss: a favorable prognostic factor in low-grade gliomas. Ann Neurol 58(2): 322–26CrossRefPubMedGoogle Scholar
- 27.Pallud J, Capelle L, Taillandier L, Fontaine D, Mandonnet E, Guillevin R, Bauchet L, Peruzzi P, Laigle-Donadey F, Kujas M, Guyotat J, Baron MH, Mokhtari K, Duffau H (2008) Prognostic Significance of Imaging Contrast Enhancement for WHO grade II Gliomas. Neuro Oncol [Epub ahead of print]Google Scholar
- 29.Pignatti F, van den Bent M, Curran D, Debruyne C, Sylvester R, Therasse P, Afra D, Cornu P, Bolla M, Vecht C, Karim AB; European Organization for Research and Treatment of Cancer Brain Tumor Cooperative Group; European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20(8): 2076–84CrossRefPubMedGoogle Scholar
- 30.Quinn JA, Reardon DA, Friedman AH, Rich JN, Sampson JH, Provenzale JM, McLendon RE, Gururangan S, Bigner DD, Herndon JE 2nd, Avgeropoulos N, Finlay J, Tourt-Uhlig S, Affronti ML, Evans B, Stafford-Fox V, Zaknoen S, Friedman HS (2003) Phase II trial of temozolomide in patients with progressive low-grade glioma. J Clin Oncol 21(4): 646–51CrossRefPubMedGoogle Scholar
- 32.Rees J, Watt H, Jäager HR, Benton C, Tozer D, Tofts P (2008) Waldman volumes and growth rates of untreated adult low-grade gliomas indicate risk of early malignant transformation. Eur J Radiol [Epub ahead of print]Google Scholar
- 35.Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E, Kujas M, Mokhtari K, Taillibert S, Laigle-Donadey F, Carpentier AF, Omuro A, Capelle L, Duffau H, Cornu P, Guillevin R, Sanson M, Hoang-Xuan K, Delattre JY (2007) Dynamic history of lowgrade gliomas before and after temozolomide treatment. Ann Neurol 61(5): 484–90CrossRefPubMedGoogle Scholar
- 43.Whittle IR 2004. The dilemma of low-grade glioma. J Neurol Neurosurg Psychiatry 75 (Suppl 2): ii31–36Google Scholar