title: Neoadjuvant chemotherapy may optimize the extent of resection of World Health Organization grade II gliomas: a case series of 17 patients.
abstract: The involvement of eloquent brain areas may preclude the total/subtotal surgical resection of diffuse low-grade gliomas (DLGGs). The feasibility and functional tolerance of neoadjuvant chemotherapy have been demonstrated in such cases. The present study assesses the clinical and radiological impact of neoadjuvant chemotherapy on the natural course of DLGG. Seventeen patients without feasible surgical resection (infiltration of functional areas and/or large contralateral extension) were retrospectively selected. Temozolomide based neoadjuvant chemotherapy was initiated, inducing a tumor volume decrease and allowing a functional based maximal surgical resection. The median follow-up since initial radiological diagnosis was 5.9 years (range, 1.4-11). The median time to malignant transformation was 5.9 years. Six patients (35 %) had 1p19q codeletion, 12 patients (70 %) with IDH mutation and MGMT promoter methylation, and eight patients (47 %) had p53 overexpression. Chemotherapy reduced tumor volume (median -35.6 %, range -61.6 to -5.1 %) in contralateral hemisphere through the corpus callosum in seven cases (41 %) and in ipsi-lesional functional areas in ten cases (59 %). Chemotherapy significantly decreased the imaging tumor growth (measured by the velocity of diametric expansion VDE) with a median of -3.2 mm/year (range, -29.8 to -0.9 mm/year) (p < 0.001). A tumor volume decrease of more than 20 % was correlated with a lower postoperative residual tumor (median 2 cc, p = 0.04), a greater extent of resection (93.1 vs. 89.5 %), a higher probability of total/subtotal removal. Neoadjuvant chemotherapy with Temozolomide could optimize the surgical resection of DLGGs and could impact their natural history. Further large prospective studies with long-term follow-up are needed.
authors.affiliation: Neuro-Oncology Unit, Nancy University Hospital, 29, Avenue du Maréchal Lattre de Tassigny, 54035, Nancy, France. blonski-marie@orange.fr
authors.forename: Marie
authors.initials: M
authors.lastname: Blonski
authors.forename: Johan
authors.initials: J
authors.lastname: Pallud
authors.forename: Catherine
authors.initials: C
authors.lastname: Gozé
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mandonnet
authors.forename: Valérie
authors.initials: V
authors.lastname: Rigau
authors.forename: Luc
authors.initials: L
authors.lastname: Bauchet
authors.forename: Michel
authors.initials: M
authors.lastname: Fabbro
authors.forename: Patrick
authors.initials: P
authors.lastname: Beauchesne
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Baron
authors.forename: Denys
authors.initials: D
authors.lastname: Fontaine
authors.forename: Philippe
authors.initials: P
authors.lastname: Peruzzi
authors.forename: Amélie
authors.initials: A
authors.lastname: Darlix
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
authors.forename: Luc
authors.initials: L
authors.lastname: Taillandier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D000077204:Temozolomide; D047368:Tumor Burden; D014944:World Health Organization; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014408:Biomarkers, Tumor; D003606:Dacarbazine; D000077204:Temozolomide