Interactions between diffuse low-grade glioma (DLGG) and brain plasticity

Abstract

The traditional view in neurooncology is to see first the tumor, with very few considerations concerning the brain. However, to select the best treatment for each patient with a DLGG, that is, to optimize the onco-functional balance, the understanding of the natural history of this chronic disease is not sufficient. One should also study the reaction of the central nervous system elicited by the growth and migration of the glioma. Indeed, due to strong interactions between DLGG and the brain, cerebral adaptive phenomena often occur in order to maintain neurological and cognitive functions, namely, to compensate the spreading of this diffuse tumor. Here, the purpose is to investigate mechanisms underlying such brain plasticity, with the goal to tailor the optimal management according to the dynamic relationships between DLGG course and cerebral functional reorganization at the individual level. Beyond the fundamental interest, it is crucial for the (surgical) neurooncologist to improve his knowledge of brain hodotopy to elaborate new therapeutic strategies, such as multistage surgical approach, made possible thanks to cerebral remapping over years. Therefore, cognitive neurosciences seem to represent a precious help to neurooncology by opening new avenues to improve both quality of life and median survival in DLGG patients, that is, to move toward functional neurooncology.