Neoadjuvant chemotherapy may optimize the extent of resection of World Health Organization grade II gliomas: a case series of 17 patients

• Published in: Journal of neuro-oncology 2013-06, Vol.113 (2), p.267-275
• Main Authors: Blonski, Marie, Pallud, Johan, Gozé, Catherine, Mandonnet, Emmanuel, Rigau, Valérie, Bauchet, Luc, Fabbro, Michel, Beauchesne, Patrick, Baron, Marie-Hélène, Fontaine, Denys, Peruzzi, Philippe, Darlix, Amélie, Duffau, Hugues, Taillandier, Luc
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic Agents, Alkylating - therapeutic use; Biomarkers, Tumor - analysis; Brain Neoplasms - drug therapy; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Clinical Study; Combined Modality Therapy; Dacarbazine - analogs & derivatives; Dacarbazine - therapeutic use; Female; Follow-Up Studies; Glioma - drug therapy; Glioma - pathology; Glioma - surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Grading; Neurology; Neurosurgical Procedures; Oncology; Prognosis; Prospective Studies; Retrospective Studies; Survival Rate; Tumor Burden; World Health Organization; Young Adult
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-013-1106-6

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