Paradoxes of evidence-based medicine in lower-grade glioma: To treat the tumor or the patient?

摘要: Brain lower-grade gliomas (LGG) usually occur in young adults who enjoy an active life. This tumor has a high risk of malignant transformation resulting neurologic deterioration and finally death. Early multistage therapeutic management can increase survival over 10 years. Preservation functional neural networks quality life is crucial. In the era evidence-based medicine, issues discussed are those associated with design, analysis, clinical application randomized controlled trials (RCTs) for LGG. RCTs should take account following: considerable variability natural course LGG; limited prognostic value molecular biology at individual level; large brain organization across patients; technical conceptual progress therapies years; combination or repetition iterative treatments, taken as whole not only isolation; long-term consequences on oncologic outcomes. As it difficult to translate results RCT into benefits unique patient LGG, personalized decisions must be made by considering behavior, pattern neuroplasticity, needs, administrating standardized protocol exclusively based RCT.