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Oncological, cognitive, and employment outcomes in a series of patients with IDH-mutated glioma resected following neoadjuvant chemotherapy

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Abstract

Purpose

Maximal safe tumor resection is the first line of treatment for IDH-mutated gliomas. However, when upfront surgical resection is deemed unsatisfactory due to tumor size and location, chemotherapy could represent an interesting alternative for reducing glioma extension and allowing for a safer and more efficient removal.

Methods

We performed a retrospective study (June 2011 to December 2021) on patients with IDH-mutated gliomas undergoing chemotherapy with a neoadjuvant intent, followed by surgical excision in awake conditions. MRI-imaging follow-up was conducted every 3–6 months. Neuropsychological assessments (NPSA) were performed for all patients before surgery, during post-operative period, and at later follow-up, and patients were periodically interviewed about their clinical and job status.

Results

We included 6 patients who underwent awake surgery after neoadjuvant chemotherapy (temozolomide in 5 cases, PCV in 1 case) for an IDH-mutated glioma (3 oligodendrogliomas and 3 astrocytomas). Median tumor volume reduction was 47%, allowing for complete resection in one patient, subtotal resection in 4 patients, and partial resection in 1 patient. No major adverse effects were observed under chemotherapy. At the 4 months NPSA, a worsening of flexibility was observed in 2 patients (verbal fluencies in one case and trail making test in the other). Three out of the four patients working full time before procedure resumed their job full time, after a 7 to 10 months delay.

Conclusion

Neoadjuvant chemotherapy followed by maximal safe resection can be offered to patients affected by IDH-mutated gliomas for whom upfront surgery would be inadequate. More studies are necessary given the limited size of our sample.

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Acknowledgements

EM was supported by INSERM (Contrat Interface 2018).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris, France

    Marco Bursi, Marion Barberis, Isabelle Poisson, Sébastien Froelich & Emmanuel Mandonnet

  2. Department of Medical Oncology, Groupe Hospitalier Privé Ambroise Paré – Hartmann, Paris, France

    Claudia Rizzo

  3. Université de Paris Cité, Paris, France

    Jacqueline Lehman-Che, Homa Adle-Biassette, Sébastien Froelich & Emmanuel Mandonnet

  4. Department of Molecular Biology, Saint-Louis Hospital, 2 rue Ambroise Paré, 75010, Paris, France

    Jacqueline Lehman-Che

  5. Department of Histopathology, Lariboisière Hospital, AP-HP, Paris, France

    Homa Adle-Biassette

  6. Frontlab, Paris Brain Institute, CNRS UMR 7225, INSERM U1127, Paris, France

    Emmanuel Mandonnet

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  1. Marco Bursi
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Correspondence to Emmanuel Mandonnet.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of Lariboisière Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Oral consent to use clinical data for research purpose was collected in written by the clinicians.

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Bursi, M., Rizzo, C., Barberis, M. et al. Oncological, cognitive, and employment outcomes in a series of patients with IDH-mutated glioma resected following neoadjuvant chemotherapy. Acta Neurochir 165, 2461–2471 (2023). https://doi.org/10.1007/s00701-023-05711-6

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