Overview
Background Lower-grade-gliomas affect young patients, thus the longest progression-free-survival (PFS) with a high level quality of life is crucial. Surgery most significantly impacts on tumor natural history, postponing recurrence, improving symptoms, decreasing the need of adjuvant therapies, with extent of resection, gross-total and supra-total (GTR and STR), strongly associating with longest PFS. Achievement of GTR or STR depends on the degree of functional reorganization induced by glioma. Consequently, a successful treatment fostering neural circuit reorganization before surgery, would increase the chance of GRT/STR.
Hypothesis The plastic potential of motor system suggests that reorganization of circuits controlling hand movements could be presurgically fostered in LGG patients by enhancing plasticity with up-front motor-rehabilitation and/or by decreasing tumor infiltration with up-front chemotherapy. Advanced neuroimaging allows to infer the neuroplasticity potential. Intraoperative assessment of the motor circuits functionality will validate reliability of preoperative analyses.
Aims The project has 4 aims, investigating: A) the presurgical functional (FC) and structural (SC) connectomics of the hand-motor network to picture the spontaneous reorganization and the influence of clinical, imaging and histomolecular variables; B) the dynamic of FC and SC after tumor resection; C) changes in FC and SC maps after personalized upfront motor rehabilitation and/or chemotherapy; D) the effect of FC and SC upfront treatment on the achievement of GTR/STR preserving hand dexterity.
Experimental Design Resting-state fMRI and diffusion-MRI will provide FC and SC maps pre- and post-surgery; personalized up-front motor rehabilitation and/or chemotherapy will be administered; Intraoperative brain mapping procedures will generate data to validate the maps.
Expected Results
- Provide a tool to render the motor functional reorganization predictive of surgical outcome.
- Identify demographic, clinical and imaging variables associated with functional reorganization.
- Describe the gain induced by up-front treatment.
- Distinguish "patterns" predicting chance for GTR/STR from "patterns" suggesting need for up-front treatment.
Impact On Cancer Results will increase the achievement of GTR/STR, preserving motor integrity, with dramatic impact on LGGs natural history.
Eligibility
Inclusion Criteria (ARM 1):
- Patients signing informed consent for participation in the study
- Males and females
- Age ≥ 18 years
- Patients with lower-grade gliomas with involvement of the motor pathways who are candidates for surgery
Inclusion Criteria (ARM 2/3/4):
- Patients signing informed consent for participation in the study
- Males and females
- Age ≥ 18 years
- Patients with lower-grade gliomas treated over two years with tumors only biopsied and/or partially resected and eligible for second surgery
Exclusion Criteria:
- Age <18 years
- Inability to adhere to standard study controls
- Subjects unable to understand and freely provide consent to the study