Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies.
Sam NgHugues DuffauPublished in: Cancers (2023)
The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.
Keyphrases
- low grade
- white matter
- high grade
- radical prostatectomy
- decision making
- end stage renal disease
- robot assisted
- prostate cancer
- multiple sclerosis
- newly diagnosed
- early stage
- chronic kidney disease
- radiation therapy
- pain management
- cerebral ischemia
- mild cognitive impairment
- climate change
- peritoneal dialysis
- squamous cell carcinoma
- coronary artery disease
- risk assessment
- radiation induced
- prognostic factors
- chronic pain
- percutaneous coronary intervention
- smoking cessation
- blood flow
- free survival
- replacement therapy
- cerebral blood flow