The silent phase of diffuse low-grade gliomas. Is it when we missed the action?

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• 作者：Johan Pallud (1) (2)
  Laurent Capelle (3)
  Luc Taillandier (4)
  Mathilde Badoual (5)
  Hugues Duffau (6) (7)
  Emmanuel Mandonnet (5) (8) (9)
  
• 关键词：diffuse low ; grade glioma ; silent phase ; MRI screening
• 刊名：Acta Neurochirurgica
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：155
• 期：12
• 页码：2237-2242
• 全文大小：
• 作者单位：Johan Pallud (1) (2)
  Laurent Capelle (3)
  Luc Taillandier (4)
  Mathilde Badoual (5)
  Hugues Duffau (6) (7)
  Emmanuel Mandonnet (5) (8) (9)
  
  1. Department of Neurosurgery, Saint-Anne Hospital, Paris, France
  2. University of Paris 5, Paris, France
  3. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
  4. Department of Neurology, University Hospital, Poitiers, France
  5. IMNC, UMR 8165, Orsay, France
  6. Department of Neurosurgery, H?pital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France
  7. Institute of Neuroscience of Montpellier, INSERM U1051, Montpellier, France
  8. University of Paris 7, Paris, France
  9. Department of Neurosurgery, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France
  
• ISSN：0942-0940

文摘

Background It is commonly believed that, before being diagnosed after onset of symptoms, diffuse low-grade glioma evolve silently for a long time. The present study aimed to estimate for the first time the exact duration of this silent phase, during which the glioma is radiologically visible but undiscovered. Methods We retrospectively reviewed our French national database of diffuse low-grade glioma, searching for patients with an MRI-based assessment of their velocity of diameter growth at diagnosis and before any treatment (at least three MRIs over more than 6?months). For each patient, the duration of the silent phase was estimated by the formula: duration = initial diameter / initial velocity of growth. Results A total of 148 patients were included in the study. The mean lead-time duration (i.e., duration of the silent phase) was 14.0?±?7.8?years (median, 11.6 ; range, 1.6-39.4). The lead-time is statistically not correlated to the tumor volume. It is markedly decreasing with the velocity of diameter expansion. Conclusions Diffuse low-grade glioma are radiologically detectable but clinically silent for more than a decade. Such a long period of silent evolution could explain our current failure to cure these tumors. It can also be viewed as a window of opportunity to detect these tumors earlier, suggesting the need to set up a screening program.