Postoperative follow-up of diffuse low-grade gliomas with WHO III./IV. lesions

WHO II.grade diffuse low-grade glioma (DLGG) is a rare brain tumor that develops in young patients and has a risk of proliferating and turning into malignancy.
DLGG malignant progression can be continuously from LEVEL II.to III./IV.grade progression, in surgically removed DLGG specimens can be found to contain malignant tumors, such as III. interstitial degenerative glioma or IV.grade secondary glioblastoma.
recommends early postoperative assisted chemotherapy.
, however, there is currently debate as to whether some selective cases can be delayed.
Amelie Darlix of the Oncology Department at montpellier University Hospital in France and other retrospective analyses of the functional recovery and survival of DLGG patients with malignant tumor components who delayed complementary therapy after surgery were published online in January 2020.
the study included 44 DLGG patients, 50 percent of men, aged 21-63 and with a medium age of 36.
26% of patients were asymptomatic, with the remaining major symptoms as epilepsy.
the average age of first symptoms was 36 years, the age of imaging diagnosis was 20-63 years, and the middle age was 34.
98% of patients with craniofacial MRIs showed a single lesions.
only 1 case has two lesions, each located in the left auxiliary movement area and the left temporal lobe.
52% of the lesions are located in the left hemisphere of the brain.
of lesions: 48% of the frontal lobe, 30% of the temporal lobe, 11% of the frontal lobe, 5% of the frontal lobe, 5% of the top lobe and 2% of the temporal pillow leaf.
59% of patients had a maximum < diameter of 6cm.
patient lesions did not cross the midline, only 2 cases of deep structure.
tumor growth rate of 0.5-9.8mm/year, with a medium of 3.6mm/year.
imaging diagnosis and surgery between 1-132 months, with a medium of 7 months.
30% preoperative MRI lesions were strengthened, and FLAIR imaging showed tumor volume 3.0-174.0cm3 with a median of 51.0cm3.
95% of patients underwent wake-up surgery.
postoperative FLAR image showed a residual tumor volume of 0.0-15.0cm3, with a median of 1.8cm 3.
the degree of excision was determined according to FLAR imaging, 75% of patients had residual tumor volume ≤15cm3, which was a secondary full cut;
results, 38 (88%) of patients were diagnosed with IDH mutations, of which 37 were IDH1 mutations and 1 IDH2 mutations.
26 cases (59%) of the total number of astromas, 18 (41%) were 1p19q co-missing.
45% of tumors were diffuse astromas, IDH mutants, 14% star cell tumors, IDH wild types, and 41% were rare glioblastomas, IDH mutants and 1p19q co-missing types.
at least 1 malignant lesions were found in all level II. tumors with no malignant lesions on the edge, 57% of grade II.grade tumors contained multiple malignant lesions, 51% were <1 cm of micro-lesions and 49% were ≥1 cm lesions.
Tumor grading: 39% for II. Asstar cell tumors to III. Asstar cell tumors, 20% for secondary glioblastoma and II. Asstar cell tumors into IV. Asstar cell tumors, and 41% of patients for II. Stage AB glioblastoma transformation III.
cell proliferation and heterogeneity increased significantly in all patients.
46% of as astromas and 11% of less dexterity glioblastomas had an increase in fibrosis.
visible necrosis in 1 case of IV.grade lesions.
the Ki67 lesions proliferation index (Ki67) was ≤5 per cent, or 11 per cent, 5-12 per cent, 43 per cent and >12 per cent 45 per cent.
follow-up was clinical and imaging in all patients after surgery, and the medium follow-up time was 6.7 years (95% CI, 5.9-7.6).
41 (93%) patients showed tumor progression, of which 33 (75%) FLAR imaging suggested tumor progression, and the remaining 8 cases of lesions intensified to show progress.
39 patients (89%) received follow-up anti-tumor treatment, including re-surgery or chemotherapy, with a gap of 3.2 years (95% CI, 2.3-4.0) from the first surgery.
treatment included 10 cases of re-surgery, 28 cases of chemotherapy for thymosamine, and 1 case of radiotherapy.
between surgery and assisted chemotherapy was 3.4 years (95% CI, 2.3-4.1).
100 per cent, 91 per cent, 77 per cent and 57 per cent of patients who did not receive medication for 12, 18, 24 and 36 months after surgery.
single-factor analysis found that delayed follow-up treatment was related to the following factors, older, of which the median interval between ≥36.5 years and <36.5 years was 5.4 to 2.0 years (p<0.01); The former FLARE image showed that the tumor was smaller, of which <51cm3 to ≥51cm3 had a median interval of 5.8 to 2.3 years (p<0.0<1); .8cm 3 is 5.4 to 2.6 years (p<0.01) compared to the median time interval of 1≥1.8cm 3, and the median interval between less protrusive glioblastomas is 5.7 to 2.3 years (p<0.01) p<0.01) and the tumor growth rate is slow, where <3.6mm/y ratio ≥3.6mm/y median time interval is 3.9 to 2.3 years (p=0.02).
19 patients (43%) received radiotherapy at a 9.5-year interval after surgery.
9 patients (20%) died and did not reach the mid-OS when the mid-level follow-up time was 6.7 years.
100 per cent, 98 per cent, 95 per cent and 67 per cent, respectively, for 24, 36, 60 and 84 months after surgery.
single-factor analysis found that assertic cell tumors were associated with OS compared to less protruding glioblastomas, increased filamentation activity, and the strengthening of lesions during the first progression after surgery.
patients with IV.grade lesions and 6 cases containing LEVEL III lesions.
lesions level (III./IV.) is not associated with OS.
patients who survived, 25 (71%) returned to normal social activities, 19 of whom returned to full-time work.
KPS score 70-100, with a median score of 90.
all patients had seizures under control, with 85% having no seizures and 15% having rare seizures.
Conclusion The results show that it is feasible for DLGG patients to delay chemotherapy-assisted treatment after surgery or second full excision, and can maintain cognitive function and quality of life without affecting survival.
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