The Concept of onco-functional balance in the management of DLGG

Abstract

Nowadays, management of DLGG is conceptualized as a multi-stages therapeutic sequence of the different treatment modalities that are surgery, chemotherapy, radiation therapy and concomitant radio-chemotherapy. The timing and order of the sequence steps has to be fitted to each patient, taken into consideration both tumor and patient's characteristics. The aim is to optimize both survival and functional status, in order to give to patients the best chances to enjoy a normal life all along the duration of this chronic disease. Consequently, the onco-functional balance of each treatment modality has to be updated all along the evolution, with the goal to select the best treatment at each step, while keeping also in mind the next step. In other words, one needs to be one step ahead. Indeed, the overall efficacy of a treatment cannot be assessed per se, as it will depend on its integration in the whole sequence. At the first level, one needs to be able to evaluate the oncological benefit and the functional risk of each treatment type, independently of its integration in the sequence. At the second level, the same balance has to be reevaluated in the global view of a recursive multi-steps approach. We thus propose in this paper to systematically review how to estimate the onco-functional balance for surgery, chemotherapy, and radiation therapy, successively on these two levels.