SURG-31. INCIDENTAL LOW GRADE GLIOMAS: “WAIT AND SEE” OR “SURGERY”

Abstract

OBJECTIVES: Incidental low grade gliomas (ILGGs) of adults have a more variable biologicaql behavior for which the value of treatment and the timing of treatment are of less clear-cut value than for their malignant gliomas. A series of retrospective reviews provides conflicting and inconclusive results about the role of observation, stereotactic biopsy, aggressive surgery, and radiation for treating these tumors, and there exists significant variability on the therapeutic approach on the part of clinicians and in the clinical course of the disease in individual patients. METHODS: Between Oct 2010 and Feb 2017, 295 patients underwent intracranial glioma surgery in Bundang CHA Medical Center. Among them, 21 ILGGs surgery was done. Clinical, radiological and treatment data of the patients were collected and ILGGs were retrieved. RESULTS: Twenty one ILGGs (35.6%) were identified while 38 patients had symptomatic LGGs. The reasons for patients with IDLGGs having radiological examination included headache (47.6%), health checkup (23.8%), dizziness (19%) and trauma (9%). Clinically, patients with ILGGs had higher preoperative KPS, smaller tumor volume, lower frequency of eloquent areas involvement, longer survival and higher rate of complete resection comparing to those with symptomatic LGGs. Among “wait and see” treatment policy patient, 6 patient's tissue diagnosis were confirmed to high grade transformation. A critical reason for positive effect of resection on outcome resides in the impact it makes on reducing the risk of malignant transformation. Another reason to not wait and observe the lesion is the inability of any imaging modality to confirm without adequate tissue sampling that the glioma is low-grade, LGGs may have anaplastic components. CONCLUSION: Although a “wait and see” attitude has been advocated by some authors with respect to ILGGs, our case demonstrates that transformation to high grade glioma may occur. Therefore, we propose consideration of earlier resection in ILGGs.