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Survey on current practice within the European Low-Grade Glioma Network: where do we stand and what is the next step?
Emmanuel Mandonnet1, Michel Wager1, Fabien Almairac1
1Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France (E.M.); University Paris 7, Paris, France (E.M.); IMNC UMR8165, Orsay, France (E.M.); Department of Neurosurgery, Poitiers University Hospital, INSERM U1084, Poitiers, France (M.W.); Department of Neurosurgery, Hôpital Pasteur II, University Hospital of Nice, Nice, France (F.A., D.F.); Department of Radiotherapy, CHU of Besançon, Besançon, France (M.H.B.); Department of Neurooncology, Nancy neurological hospital, Nancy, France (M.B., L.T.); Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria (C.F.F.); Department of Neurosurgery & Gamma Knife, Cannizzaro General Hospital, Catania, Italy (F.B.); Department of Neurosurgery, Saint-Anne Hospital, Paris, France (J.P.); Neuroscience Research Center, Lausanne University Hospital, Lausanne, Switzerland (M.H.); Department of Neurosurgery, Hospital Garcia de Orta, Almada, Portugal (C.V.); Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden (M.Z.); Department of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy (G.S.); Leeds General Infirmary, Leeds, UK (J.G.); Department of Neurosurgery, St Elisabeth Hospital, The Netherlands (G.J.R.); Neurosurgical Department of Aristotelian University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece (N.F.); Department of Medical Oncology, Institut régional du Cancer de Montpellier ICM, Montpellier, France (A.D.); Department of Neurosurgery, Azienda ospedaliero - universitaria SMM, Udine, Italy (M.S.); Department of Neurological Surgery, Hospital Universitario Marqués de Valdecilla and Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain (J.M.); Department of Neurosurgery, Medical University of Graz, Graz, Austria (G.V.C.); Department of Anesthesiology, Lariboisière hospital, APHP, Paris, France (C.M., E.G.); VU University Medical Center, Amsterdam, Netherlands (P.D.W.H.); Department of Neurosurgery, Hospital Quiron, Madrid, Spain (S.G.B.); Instituto de Investigacion BIOCRUCES, Bilbao, Spain (S.G.B.); Department of Neurosciences, Division of Neurosurgery, Structural and Functional Connectivity Lab Project, 'S. Chiara' Hospital, Trento, Italy (S.S.); Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK (T.S.); Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy (L.B.); Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany (M.T.F.); Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier (H.D.).
Abstract:
Diffuse low-grade glioma form a rare entity affecting young people. Despite advances in surgery, chemotherapy, and radiation therapy, diffuse low-grade glioma are still incurable. According to current guidelines, maximum safe resection, when feasible, is the first line of treatment. Apart from surgery, all other treatment modalities (temozolomide, procarbazine-CCNU-vincristine regimen, and radiation therapy) are handled very differently among different teams, and this in spite of recent results of several phase 3 studies. Based on a European survey, this paper aimed to get a picture of this heterogeneity in diffuse low-grade glioma management, to identify clinically relevant questions raised by this heterogeneity of practice, and to propose new methodological frameworks to address these questions.
Insights
Diffuse low-grade gliomas remain incurable despite advances. This study highlights significant variations in managing these rare brain tumors, even after major clinical trials, prompting a need for standardized approaches.
Area of Science:
- Neuro-oncology
- Clinical Practice Management
- Rare Diseases
Background:
- Diffuse low-grade gliomas (DLGG) are rare brain tumors primarily affecting young individuals.
- Current treatments including surgery, chemotherapy, and radiation therapy have not led to a cure for DLGG.
- Maximum safe surgical resection is the recommended first-line treatment when feasible.
Purpose of the Study:
- To assess the heterogeneity in the management of diffuse low-grade glioma across European centers.
- To identify key clinical questions arising from variations in DLGG treatment practices.
- To propose novel methodological frameworks for addressing these clinical questions and improving DLGG management.
Main Methods:
- A European survey was conducted to gather data on current clinical practices for diffuse low-grade glioma.
- Analysis focused on identifying variations in treatment modalities beyond initial surgical resection.
- The study aimed to pinpoint areas of clinical uncertainty and differing expert opinions.
Main Results:
- Significant heterogeneity exists in the management of diffuse low-grade glioma, particularly regarding non-surgical treatments like chemotherapy and radiation therapy.
- Treatment decisions vary considerably among different clinical teams, despite recent phase 3 study results.
- This practice variation raises clinically relevant questions regarding optimal therapeutic strategies for DLGG.
Conclusions:
- The management of diffuse low-grade glioma exhibits considerable variability across European institutions.
- There is a pressing need to address this heterogeneity to improve patient outcomes and standardize care.
- New methodological approaches are required to effectively answer critical questions stemming from current practice variations in DLGG treatment.
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