Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies

SIMPLE SUMMARY: Diffuse low-grade gliomas promote widely distributed mechanisms of cerebral plasticity, which are critical to maintaining brain functions. These neurobiological processes are highly correlated to the success and the risks of therapies, and, reciprocally, current treatment options have a critical effect on the long-term potentiation or inhibition of plasticity. In this narrative review, we discuss current clinical, radiological, and oncological markers that reflect plasticity potentials and limitations in the context of low-grade glioma management, and we further highlight how plasticity interacts with spontaneous and therapeutic factors. Finally, we propose a multimodal and multistage oncological approach that integrates individual brain plasticity profiling as a support to a step-by-step therapeutic decision making. ABSTRACT: The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.