The landscape of postsurgical recurrence patterns in diffuse low-grade gliomas

Area of Science:

• Neuro-oncology
• Surgical Oncology
• Pathology

Background:

• Current diffuse low-grade glioma (DLGG) treatment involves maximal safe surgical resection and adjuvant therapy.
• While effective in delaying malignant transformation (MT), DLGG frequently recurs, often locally, necessitating reoperation or further treatment.
• Prolonged survival reveals atypical recurrence patterns beyond typical local regrowth.

Purpose of the Study:

• To review atypical patterns of DLGG recurrence.
• To discuss the pathophysiological mechanisms underlying these unusual patterns.
• To guide adaptation of treatment strategies for DLGG relapse.

Main Methods:

• Literature review of atypical diffuse low-grade glioma recurrence patterns.
• Analysis of emerging recurrence characteristics during long-term follow-up.
• Discussion of pathophysiological basis and treatment implications.

Main Results:

• Identified atypical DLGG recurrence patterns including diffuse gliomatosis, multicentric recurrence, leptomeningeal dissemination, acute MT, and bulky cavity relapse.
• These patterns emerge due to prolonged patient survival.
• Understanding these patterns is crucial for effective management.

Conclusions:

• Atypical recurrence patterns in DLGG necessitate revised therapeutic strategies.
• Further research into basic mechanisms can inform novel treatment approaches.
• Tailored strategies are essential for managing diverse DLGG relapse scenarios.