Department of Neurosurgery, Charles Nicolle Hospital, Rouen University Medical Center, Rouen, France.
Department of Neurosurgery, Enfant-Jésus Hospital, CHU de Québec, Laval University, Québec, Qc, Canada.
Crit Rev Oncol Hematol. 2019 Jun;138:148-155. doi: 10.1016/j.critrevonc.2019.04.009. Epub 2019 Apr 15.
Early and maximal safe surgical resection optionally followed by adjuvant treatment is currently recommended in diffuse low-grade glioma (DLGG). Although this management delays malignant transformation (MT), recurrence will most often occur. Because this relapse usually arises locally, reoperation can be considered, with possible further chemotherapy/radiotherapy. However, due to a prolonged overall survival, a large spectrum of unusual recurrence patterns begins to emerge during long-term follow-up, beyond the classical slow and local tumor re-growth. We review various atypical patterns of DLGG relapse, we discuss their pathophysiological mechanisms and how to adapt the treatment(s). Those patterns include very diffuse, ipsi- or bilateral gliomatosis-like progression, multicentric recurrence with emergence of remote low-grade or high-grade glioma, leptomeningeal dissemination, acute (early or delayed) local MT or bulky relapse into the operating cavity. This landscape of recurrence patterns may allow physicians to elaborate new tailored therapeutic strategies and scientists to develop original hypotheses for basic research.
目前推荐对弥漫性低级别胶质瘤（DLGG）进行早期和最大限度的安全手术切除，然后进行辅助治疗。尽管这种治疗方法延迟了恶性转化（MT），但复发通常会发生。由于这种复发通常发生在局部，因此可以考虑再次手术，可能还需要进一步的化疗/放疗。然而，由于总生存时间延长，在长期随访期间，除了经典的缓慢和局部肿瘤再生长之外，开始出现各种不典型的复发模式。我们回顾了各种不典型的 DLGG 复发模式，讨论了它们的病理生理机制以及如何调整治疗方法。这些模式包括非常弥漫性、同侧或双侧神经胶质瘤样进展、多中心复发伴远处低级别或高级别胶质瘤的出现、软脑膜播散、急性（早期或延迟）局部 MT 或大块复发进入手术腔。这种复发模式的情况可能使医生能够制定出新的针对性治疗策略，使科学家能够为基础研究提出新的假设。
