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Spatial distribution of malignant transformation in patients with low-grade glioma.

Journal article
Authors Asgeir Store Jakola
David Bouget
Ingerid Reinertsen
Anne J Skjulsvik
Lisa Millgård Sagberg
Hans Kristian Bø
Sasha Gulati
Kristin Sjåvik
Ole Solheim
Published in Journal of neuro-oncology
Volume 146
Pages 373-380
ISSN 1573-7373
Publication year 2020
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Pages 373-380
Language en
Links dx.doi.org/10.1007/s11060-020-03391...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Cancer and Oncology, Neurology, Neurosurgery

Abstract

Malignant transformation represents the natural evolution of diffuse low-grade gliomas (LGG). This is a catastrophic event, causing neurocognitive symptoms, intensified treatment and premature death. However, little is known concerning the spatial distribution of malignant transformation in patients with LGG.Patients histopathological diagnosed with LGG and subsequent radiological malignant transformation were identified from two different institutions. We evaluated the spatial distribution of malignant transformation with (1) visual inspection and (2) segmentations of longitudinal tumor volumes. In (1) a radiological transformation site < 2 cm from the tumor on preceding MRI was defined local transformation. In (2) overlap with pretreatment volume after importation into a common space was defined as local transformation. With a centroid model we explored if there were particular patterns of transformations within relevant subgroups.We included 43 patients in the clinical evaluation, and 36 patients had MRIs scans available for longitudinal segmentations. Prior to malignant transformation, residual radiological tumor volumes were > 10 ml in 93% of patients. The transformation site was considered local in 91% of patients by clinical assessment. Patients treated with radiotherapy prior to transformation had somewhat lower rate of local transformations (83%). Based upon the segmentations, the transformation was local in 92%. We did not observe any particular pattern of transformations in examined molecular subgroups.Malignant transformation occurs locally and within the T2w hyperintensities in most patients. Although LGG is an infiltrating disease, this data conceptually strengthens the role of loco-regional treatments in patients with LGG.

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