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

摘要: Early and maximal safe surgical resection optionally followed by adjuvant treatment is currently recommended in diffuse low-grade glioma (DLGG). Although this management delays malignant transformation (MT), recurrence will most often occur. Because relapse usually arises locally, reoperation can be considered, with possible further chemotherapy/radiotherapy. However, due to a prolonged overall survival, large spectrum of unusual patterns begins emerge during long-term follow-up, beyond the classical slow local tumor re-growth. We review various atypical DLGG relapse, we discuss their pathophysiological mechanisms how adapt treatment(s). Those include very diffuse, ipsi- or bilateral gliomatosis-like progression, multicentric emergence remote high-grade glioma, leptomeningeal dissemination, acute (early delayed) MT bulky into operating cavity. This landscape may allow physicians elaborate new tailored therapeutic strategies scientists develop original hypotheses for basic research.