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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

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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.

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Authors and Affiliations

  1. Division of Neuro-Oncology, Department of Neurology, Nancy University Hospital, Nancy, France

    Marie Blonski, Luc Taillandier & Patrick Beauchesne

  2. Department of Neurology, Montpellier University Hospital, Montpellier, France

    Guillaume Herbet & Sylvie Moritz-Gasser

  3. Department of Neurosurgery, Montpellier University Hospital, Montpellier, France

    Igor Lima Maldonado, Luc Bauchet & Hugues Duffau

  4. National Institute for Health and Medical Research (INSERM)—U1051 Laboratory, Institute for Neurosciences of Montpellier, Montpellier University Hospital, Montpellier, France

    Guillaume Herbet, Igor Lima Maldonado, Catherine Gozé, Sylvie Moritz-Gasser, Luc Bauchet & Hugues Duffau

  5. Department of Oncology, Val D’Aurelle Center for Cancer Treatment, Montpellier, France

    Michel Fabbro

  6. Department of Neurology, Montpellier-Nîmes University Hospital, Nîmes, France

    Chantal Campello

  7. Hormone and Cell Biology Laboratory, Montpellier University Hospital, Montpellier, France

    Catherine Gozé

  8. Cytology and Anatomical Pathology Laboratory, Montpellier University Hospital, Montpellier, France

    Valérie Rigau

  9. Department of Radiotherapy, Val D’Aurelle Center for Cancer Treatment, Montpellier, France

    Christine Kerr

  10. Division of Neuro-Oncology, Departments of Neurosciences and Oncology, San Giovanni Battista Hospital, University of Turin, Turin, Italy

    Roberta Rudà & Riccardo Soffietti

  11. Department of Neurosurgery, Hôpital Gui de Chauliac, CHU Montpellier 80, Avenue Augustin Fliche, 34295, Montpellier, France

    Hugues Duffau

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  1. Marie Blonski
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Blonski, M., Taillandier, L., Herbet, G. et al. 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. J Neurooncol 106, 353–366 (2012). https://doi.org/10.1007/s11060-011-0670-x

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