Résumé
Objective: Diffuse low-grade gliomas (DLGG) are defined by a continuous
growth and an almost unavoidable malignant transformation. Foci of
malignant glioma can be found within DLGG samples obtained from surgical
resections. As the medical management of patients is classically based on
the higher tumor grade, an immediate adjuvant treatment is usually
proposed. To determine whether postponing the medical treatment in
selected patients is feasible, we conducted a single-center retrospective
study. Methods: Single-center retrospective analysis of a consecutive
series of DLGG managed with this conservative strategy. Inclusion criteria
were: at least one focus of malignant tumor (grade III-IV, WHO 2016), no
previous chemotherapy or radiotherapy, no less than a subtotal resection
of the FLAIR tumor volume, no intention of treating with immediate
adjuvant therapy, minimum two years of follow-up. The time interval to the
following oncological medical treatment was analyzed, as well as the
functional and survival results. Results: 45 patients met the inclusion
criteria (median age 36.5, median time interval from diagnosis: 7.3
months). Most tumors (86.7%) were IDH-mutant and 1p19q intact (60.0%); 10
presented with grade IV foci. With a median follow-up of 6.3 years, 75.5%
of patients received a subsequent medical treatment, after a median time
of 3.7 years since surgery. At the time of analysis, 9 patients (20.0%)
had died (5-years and 7-years survival rates: 95.2% and 67.0%). Most
surviving patients were still active professionally, without seizures.
Conclusions: Postponing the medical treatment in DLGG with foci of
malignant tumor following total or subtotal resection should be considered
in selected patients.