[DIFFUSE LOW GRADE GLIOMA: PERSONALIZED ADAPTATION OF SURGICAL RESECTION IN AN ERA OF TARGETED ONCOLOGICAL THERAPY]

Diffuse low grade glioma (DLGG) is a primary, infiltrative brain tumor which grows slowly but steadily and eventually undergoes malignant transformation into a high grade glioma. Today, it is hard to generalize the treatment approaches for DLGG. Due to different genetic and clinical variables, there is a large gap in the treatment provided to different patients. This kind of gap requires personalized adaptation of the treatment for a long period. Although there has been significant progress in the molecular characterization of DLGG, we still lack an efficient oncological targeted therapy. On the other hand, during the past two decades, there has been a significant paradigm shift in the treatment of DLGG, with the current recommendation to perform a maximal safe resection as first line treatment. Our aspirations to preserve the high function abilities of these relatively young patients for a long period (median overall survival of 15 years), together with the intention to postpone the malignant transformation as late as possible, have led to increases in the prevalence of awake craniotomies for DLGG. In this surgical technique, the resection of the tumor is as wide as possible, according to its functional boundaries (and not its radiological - anatomical ones). This kind of resection allows us to preserve the functioning abilities of the patients while making a wide resection. This resection can be performed with full adaptation to the patient's will, as well as for the tumor's characteristics. The long-term treatment of patients with DLGG requires us to perform personalized adaptation in any therapeutic junction and in any case where the delicate balance between function of the patient and his oncological status needs to be preserved. This study reviews the different options for personalized treatment in DLGG and emphasize the importance of awake surgeries in these cases.