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Zhang J, Chen YS, Li YP, Zhu ZQ, Liu JM, Guo CC, Yang QY, Wang XL, Rao YH, Mao Q, Li WY, Ma L, Yang YQ, Xiao SY. Postoperative functional status in patients with supratentorial superficial low-grade glioma. World J Surg Oncol 2017; 15:186. [PMID: 29041974 PMCID: PMC5645899 DOI: 10.1186/s12957-017-1237-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/20/2017] [Indexed: 02/05/2023] Open
Abstract
Background We investigated the functional status of adult supratentorial superficial low-grade glioma (ASS-LGG) after surgery and analyzed its relevant factors to guide the therapeutic strategy and improve the life quality of these patients. Methods Clinical materials from January 2008 to December 2010 in 104 adults with ASS-LGG were analyzed retrospectively. The follow-up period ranged from 6 months to 1.5 years. The logistic regression was used to evaluate the preoperative and postoperative variation of functional status in patients to disclose the relevant factors affecting postoperative functional status, such as age, gender, the duration of symptom, size and location of the tumor, hemisphere, resection degree, and tumor pathologic grade and preoperative Karnofsky performance status (Pre-KPS). Results Four out of nine candidate factors are related to the postoperative functional status. They are age less than 40 years, the size of tumor less than 5 cm in diameter, tumor located in the right hemisphere, and limited resection of tumor in the eloquent area. Conclusions It seems more meaningful to evaluate the functional status of the patients with ASS-LGG on the basis of these clinical features, involving age, tumor size, location, and extent of resection.
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Affiliation(s)
- Ji Zhang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - Yin Sheng Chen
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - You-Ping Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zheng-Quan Zhu
- Department of Neurosurgery, Tumor Hospital Affiliated of Xinjiang Medical University, Xinshi District, Ürümqi, Xinjiang, China
| | - Jian-Min Liu
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Cheng-Cheng Guo
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - Qun-Ying Yang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - Xiao-Li Wang
- Department of General Surgery, Shang Jin Nan Fu Hospital, West China Hospital, Sichuan University, Cheng du, Sichuang, China
| | - Ying-Hua Rao
- Department of Neurosurgery, Guangzhou Baiyun District People's Hospital, Guangzhou, China
| | - Qing Mao
- Department of General Surgery, West China Hospital of Sichuan University, Cheng du, Sichuang, China
| | - Wen-Yan Li
- Department of Neurosurgery, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou Province, China
| | - Lu Ma
- Department of General Surgery, West China Hospital of Sichuan University, Cheng du, Sichuang, China
| | - Yun Qiang Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Shi-Yin Xiao
- Department of Neurosurgery, The second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Bourdillon P, Hlaihel C, Guyotat J, Guillotton L, Honnorat J, Ducray F, Cotton F. Prediction of anaplastic transformation in low-grade oligodendrogliomas based on magnetic resonance spectroscopy and 1p/19q codeletion status. J Neurooncol 2015; 122:529-37. [PMID: 25716744 DOI: 10.1007/s11060-015-1737-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 02/01/2015] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess whether combining multimodal magnetic resonance imaging (MRI) with the determination of the 1p/19q codeletion status could improve the ability to predict anaplastic transformation in low-grade oligodendrogliomas. Twenty patients with grade II oligodendrogliomas were followed-up using multimodal MR [proton MR spectroscopy (MRS), perfusion, and conventional MR imaging]. All patients diagnoses were histologically proven, and 1p/19q codeletion status was analyzed for all patients. Median follow-up was 30.5 ± 11.4 months. Anaplastic transformation was observed in six patients. The only MRI feature that was associated with anaplastic transformation was an elevation of the choline/creatine ratio >2.4 which was observed in 4 out of 6 patients with anaplastic transformation versus 1 out of 14 patients without anaplastic transformation. In patients without 1p/19q codeletion, an elevation of the choline/creatine ratio >2.4 was associated with the occurrence of anaplastic transformation in all cases (4 out of 4 patients), with a mean time of 12 months. In contrast, in patients with a 1p/19q codeletion, no anaplastic transformation was observed in the patient who had an elevation of >2.4 of the choline/creatine ratio and two patients demonstrated an anaplastic transformation without any elevation of this ratio.Prospective validation in a larger series is needed, yet the present study suggests that combining data from in vivo proton MRS and genetic analysis could be a promising strategy to predict time to anaplastic transformation at the individual level in patients with low-grade oligodendrogliomas and may help deciding when chemotherapy and/or radiotherapy should be initiated in these tumors.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
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De Benedictis A, Moritz-Gasser S, Duffau H. Awake Mapping Optimizes the Extent of Resection for Low-Grade Gliomas in Eloquent Areas. Neurosurgery 2010; 66:1074-84; discussion 1084. [PMID: 20386138 DOI: 10.1227/01.neu.0000369514.74284.78] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
BACKGROUND
Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures.
OBJECTIVE
We report for the first time a series of patients who underwent 2 consecutive surgeries without and with awake mapping.
METHODS
Nine patients underwent surgery for a low-grade glioma in functional sites under general anesthesia in other institutions. The resection was subtotal in 3 cases and partial in 6 cases. There was a postoperative worsening in 3 cases. We performed a second surgery in the awake condition with intraoperative electrostimulation. The resection was performed according to functional boundaries at both the cortical and subcortical levels.
RESULTS
Postoperative magnetic resonance imaging showed that the resection was complete in 5 cases and subtotal in 4 cases (no partial removal) and that it was improved in all cases compared with the first surgery (P = .04). There was no permanent neurological worsening. Three patients improved compared with the presurgical status. All patients returned to normal professional and social lives.
CONCLUSION
Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.
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Affiliation(s)
| | - Sylvie Moritz-Gasser
- Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier, Montpellier, France
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, and Institut of Neuroscience of Montpellier, INSERM U583, Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
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Abstract
A better understanding of gliomas biology is now leading to a combined histo-molecular classification of these tumors. In anaplastic gliomas ongoing studies depend on 1p/19q codeletion status and in glioblastomas on MGMT methylation status. Advanced brain tumor imaging elicits a better identification of gliomas evolutive potential of. In low-grade gliomas, the importance of maximal resection and the role of chemotherapy are being increasingly recognized. In anaplastic gliomas, phase III studies have clarified the respective roles of chemotherapy and radiotherapy. In glioblastomas concomitant chemoradiotherapy is the standard. Most targeted therapies, namely anti-EGFR therapies have failed to demonstrate efficacy but anti-angiogenics are promising. The aim of this review is to discuss the main advances in adults' gliomas biology, imaging and treatment.
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