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

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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.

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Acknowledgments

The REG thanks Etienne Audureau from the Biostatistics and Epidemiology Unit, Hôtel-Dieu, Assistance Publique–Hôpitaux de Paris, Paris, France, for his assistance and validation of the statistical analyses.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Neuro-Oncology Unit, Nancy University Hospital, 29, Avenue du Maréchal Lattre de Tassigny, 54035, Nancy, France

    Marie Blonski, Patrick Beauchesne, Amélie Darlix & Luc Taillandier

  2. Department of Neurosurgery, Sainte-Anne Hospital, 1, rue Cabanis, 75674, Paris, France

    Johan Pallud

  3. University Paris Descartes, Paris, France

    Johan Pallud

  4. Hormone and Cell Biology Laboratory, Arnaud de Villeneuve University Hospital, 37, Avenue du Doyen Gaston Giraud, 34295, Montpellier, France

    Catherine Gozé

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

    Catherine Gozé, Luc Bauchet & Hugues Duffau

  6. Department of Neurosurgery, Lariboisière Hospital, 2, rue Ambroise Paré, 75010, Paris, France

    Emmanuel Mandonnet

  7. Cytology and Anatomical Pathology Laboratory, Gui de Chauliac University Hospital, 80, rue Augustin Fliche, 34295, Montpellier, France

    Valérie Rigau

  8. Department of Neurosurgery, Gui de Chauliac University Hospital, 80, rue Augustin Fliche, 34295, Montpellier, France

    Luc Bauchet & Hugues Duffau

  9. Department of Oncology, Val D’Aurelle Center of Cancer Treatment, 208, rue des Apothicaires, 34298, Montpellier, France

    Michel Fabbro

  10. Department of Radiotherapy, Jean Perrin Center of Cancer Treatment, 58, rue Montalembert, 63011, Clermont-Ferrand, France

    Marie-Hélène Baron

  11. Department of Neurosurgery, Pasteur University Hospital, 30, Avenue de la Voie Romaine, 06000, Nice, France

    Denys Fontaine

  12. Department of Neurosurgery, Maison Blanche University Hospital, 55, rue Cognacq Jay, 51092, Reims, France

    Philippe Peruzzi

Authors
  1. Marie Blonski
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  2. Johan Pallud
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  3. Catherine Gozé
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  4. Emmanuel Mandonnet
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  5. Valérie Rigau
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  6. Luc Bauchet
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  7. Michel Fabbro
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  8. Patrick Beauchesne
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  9. Marie-Hélène Baron
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  10. Denys Fontaine
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  11. Philippe Peruzzi
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  12. Amélie Darlix
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  13. Hugues Duffau
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  14. Luc Taillandier
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Corresponding author

Correspondence to Marie Blonski.

Additional information

This study was conducted on behalf of Réseau d’Étude des Gliomes, REG, France.

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Blonski, M., Pallud, J., Gozé, C. et al. Neoadjuvant chemotherapy may optimize the extent of resection of World Health Organization grade II gliomas: a case series of 17 patients. J Neurooncol 113, 267–275 (2013). https://doi.org/10.1007/s11060-013-1106-6

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  • DOI: https://doi.org/10.1007/s11060-013-1106-6

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