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. 2023 Jul 20;15(14):3698. doi: 10.3390/cancers15143698

Figure 2.

Figure 2

Global and dynamic onco-functional framework in an illustrative case of low-grade glioma, adapted from Ng et al. [76]. (A) Global onco-functional framework in a patient with a symptomatic 1p19q non-codeleted IDH-mutant low-grade glioma located in the left frontal lobe (reference time point I) who underwent a subtotal resection assisted with awake mapping (S1). The reference time point II shows tumor residual with a volume <10 mL. Given the favorable individual plasticity profile at recurrence (reference time point III) with a limited degree of white matter tract infiltration, no modification of the velocity of tumor expansion, and a preserved cognitive status, the patient was proposed a second surgery assisted with awake mapping (S2). Plasticity mechanisms promoted significant reallocations of functional sites, thus allowing the reduction of the volume under 10 mL again. The patient was finally administered chemotherapy (C) and radiotherapy (R) several years after the first line of oncological treatment (reference time point IV). (B) Early dynamic adaptation of the onco-functional strategy in a similar patient who was incidentally diagnosed (reference time point Ib). The patient was preventively operated with awake mapping (S1) and benefited from a supratotal resection (reference time point IIb), with regular surveillance but without adjuvant treatment. (C) Late dynamic adaptation of the onco-functional strategy: the patient underwent a third surgery (S3) at the reference time point IVc instead of radiotherapy, since chemotherapy significantly helped to reduce the white matter tract infiltration—while the glioma was an astrocytoma IDH1 mutated but 1p19q non codeleted. Evolving patterns of plasticity again allowed a subtotal resection with a tumor residual <10 mL. DES: direct electrostimulation. Note that transient cognitive declines following surgeries are common after awake, functional-guided surgery, due to brain edema (here illustrated with the blue curve inflexion following each surgical procedure). Note that the linearity of the time scale is not necessarily respected in these illustrations.