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Daily bibliographic review of the Neurosurgery Department. La Fe University Hospital. Valencia, Spain

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

Diffuse low-grade glioma

Acta Neurochir (2013) 155:2237–2242

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 6months). 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 leadtime 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.

Category: Oncology

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