title: Combination of neoadjuvant chemotherapy followed by surgical resection as a new strategy for WHO grade II gliomas: a study of cognitive status and quality of life.
abstract: Diffuse WHO grade II (GIIG) may be unresectable when involving critical structures. To assess the feasibility and functional tolerance (cognition and quality of life) of an original therapeutic strategy combining neoadjuvant chemotherapy followed by surgical resection for initially inoperable GIIG. Ten patients underwent Temozolomide for unresectable GIIG, as initial treatment or at recurrence after previous partial resection, due to invasion of eloquent areas or bi-hemispheric diffusion preventing a total/subtotal removal. Functional outcome after both treatments was assessed, with evaluation of seven cognitive domains. Chemotherapy induced tumor shrinkage (median volume decrease 38.9%) in ipsilateral functional areas in six patients and in the contralateral hemisphere in four. Only four patients had a 1p19q codeletion. The tumor shrinkage made possible the resection (mean extent of resection 93.3%, 9 total or subtotal removals) of initially inoperable tumors. Postoperatively, three patients had no deficits, while verbal episodic memory and executive functions were slightly impaired in seven patients. However, global quality of life was roughly preserved on the EORTC QLQ C30 + BN 20 (median score: 66.7%). Role functioning score was relatively reduced (median score: 66.7%) whereas KPS was preserved (median score: 90, range 80-100). Seven patients became seizure-free while three improved. This combined treatment is feasible, efficient (surgery made possible by neoadjuvant chemotherapy) and well-tolerated (preservation of quality of life, no serious cognitive disturbances). Cognitive deficits seem mostly related to tumor location. Because KPS is not reliable enough, a detailed neuropsychological assessment should be systematically performed in GIIG.
authors.affiliation: Division of Neuro-Oncology, Department of Neurology, Nancy University Hospital, Nancy, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Blonski
authors.forename: Luc
authors.initials: L
authors.lastname: Taillandier
authors.forename: Guillaume
authors.initials: G
authors.lastname: Herbet
authors.forename: Igor Lima
authors.initials: IL
authors.lastname: Maldonado
authors.forename: Patrick
authors.initials: P
authors.lastname: Beauchesne
authors.forename: Michel
authors.initials: M
authors.lastname: Fabbro
authors.forename: Chantal
authors.initials: C
authors.lastname: Campello
authors.forename: Catherine
authors.initials: C
authors.lastname: Gozé
authors.forename: Valérie
authors.initials: V
authors.lastname: Rigau
authors.forename: Sylvie
authors.initials: S
authors.lastname: Moritz-Gasser
authors.forename: Christine
authors.initials: C
authors.lastname: Kerr
authors.forename: Roberta
authors.initials: R
authors.lastname: Rudà
authors.forename: Riccardo
authors.initials: R
authors.lastname: Soffietti
authors.forename: Luc
authors.initials: L
authors.lastname: Bauchet
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D003071:Cognition / Q000187:drug effects; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods; D060787:Neoplasm Grading; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D011788:Quality of Life; D012189:Retrospective Studies; D000077204:Temozolomide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003606:Dacarbazine; D000077204:Temozolomide