Abstract
In low-grade glioma (LGG), besides the patient's neurological status and tumor characteristics on neuroimaging, current treatment guidelines mainly rely on the glioma's genetics at diagnosis to define therapeutic strategy, usually starting with surgical resection. However, this snapshot in time does not take into account the antecedent period of tumor progression and its interactions with the brain before presentation. This article reviews new concepts that pertain to reconstruct the history of previous interplay between the LGG's course and adaptive changes in the connectome within which the glioma is embedded over the years preceding the diagnosis. Microscale and macroscale parameters helpful for extrapolating backward in time are considered, both for the glioma (kinetics, migration vs. proliferation profile, metabolism with possible intratumoral heterogeneity, relationships with surrounding cerebral pathways) and for patterns of reconfiguration within and across neural networks in reaction to the LGG leading to considerable interindividual cerebral variability. Modelling these continuous variations at the time of LGG diagnosis is a prerequisite to predict recovery from treatment(s). It is important to go beyond the biology of the LGG at a given moment of its history, and instead construct a more comprehensive picture of the past and present dynamics of glioma-brain interactions, and their ongoing evolution, as a necessary stage to optimize a personalized management plan by thinking several steps ahead.
Overview
- The study focuses on reconstructing the history of low-grade glioma (LGG) prior to diagnosis, considering the interactions between the tumor and the brain's connectome over time.
- The research explores microscale and macroscale parameters to extrapolate backward in time, including glioma kinetics, migration vs. proliferation profile, metabolism, and relationships with surrounding cerebral pathways.
- The primary objective is to construct a comprehensive picture of glioma-brain interactions and their evolution, enabling a more personalized management plan and predicting recovery from treatment.
Comparative Analysis & Findings
- The study highlights the importance of considering the backstory of the LGG prior to diagnosis, as current treatment guidelines rely solely on the snapshot of the tumor's genetics and characteristics.
- The research explores the idea of reconstructing the history of LGG by modeling the continuous variations in the glioma and brain interactions at the time of diagnosis.
- The findings suggest that understanding the past and present dynamics of glioma-brain interactions can improve the prediction of recovery from treatment and inform personalized management plans.
Implications and Future Directions
- The study's findings have significant implications for the development of personalized treatment plans for LGG patients, taking into account the unique interactions between the tumor and the brain's connectome.
- Future research directions may involve the use of advanced imaging techniques, such as functional MRI or magnetic resonance spectroscopy, to study the brain's connectome and its adaptation to the glioma.
- Understanding the ongoing evolution of glioma-brain interactions may lead to the identification of novel therapeutic targets and the development of more effective treatment strategies.