Return to intensive sport activities following awake functional-guided surgical resection of IDH-mutated low-grade glioma

Abstract

Purpose: Although low-grade glioma (LGG) patients usually enjoy an active familial and socio-professional life, their ability to practice sports was poorly studied. Here, the capability to resume high-level sports following awake surgery (AS) in LGG patients who performed intensive sport activities before resection was investigated. Methods: Sporty patients who underwent AS using functional-based resection for IDH-mutated LGG were selected, with analysis of return to strenuous sport. Results: Thirty-nine patients who practiced high-level sport (9 doing competition) fulfilled the inclusion criteria (28 men, mean age 34.3 ± 8.5 years). The preoperative mean KPS score was 96.9 ± 5.2. The mean tumor volume (TV) was 37.1 ± 34.8cm3. No persistent neurological deteriorations were generated (postoperative median KPS score: 95.6 ± 5.9). 84.6% of patients returned to intensive sport activities postoperatively (including 7.7% who re-increased the intensity owing to relief of preoperative epilepsy), with 7.7% still capable to practice sports but having reduced the intensity and 7.7% who stopped sport because of intractable seizures. The mean EOR was 93.7 ± 7.5% (mean residual TV 3.3 ± 6.1cm3). Pathology revealed 28 astrocytomas and 11 oligodendrogliomas. Early adjuvant therapy was administrated in 12.8% of cases. Nineteen patients (48.7%) underwent subsequent AS. The mean follow-up duration was 7.6 ± 4.6 years, with 35 patients (89.7%) still alive. Return to sport was correlated to the EOR (p = 0.023), residual TV (p = 0.01), postoperative KPS score (p = 0.001) and pharmaco-resistant epilepsy (p < 0.0001). Conclusion: This is the first experience demonstrating that AS preserves the capacity to resume intensive sport in 84.6% of adults after LGG resection, although patients with chronic seizures decreased or stopped sport activities.