A better surgical resectability of WHO grade II gliomas is independent of favorable molecular markers

Cordier, Dominik; Gozé, Catherine; Schädelin, Sabine; Rigau, Valérie; Mariani, Luigi; Duffau, Hugues

doi:10.1007/s11060-014-1623-y

Cited by 37 publications

(18 citation statements)

References 37 publications

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“…The fraction of patients harboring LGGs with IDH mutations is comparable or slightly lower than recently published clinical studies, including a large Chinese population-based study [ 9 , 26 , 27 ]. Thus, our population-based cohorts seems representative of the LGG reported in other clinical settings as well.…”

Section: Discussionsupporting

confidence: 51%

Surgical resection versus watchful waiting in low-grade gliomas

Jakola

Skjulsvik

Myrmel³

et al. 2017

Annals of Oncology

239

136

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BackgroundInfiltrating low-grade gliomas (LGG; WHO grade 2) typically present with seizures in young adults. LGGs grow continuously and usually transform to higher grade of malignancy, eventually causing progressive disability and premature death. The effect of up-front surgery has been controversial and the impact of molecular biology on the effect of surgery is unknown. We now present long-term results of upfront surgical resection compared with watchful waiting in light of recently established molecular markers.Materials and methodsPopulation-based parallel cohorts were followed from two Norwegian university hospitals with different surgical treatment strategies and defined geographical catchment regions. In region A watchful waiting was favored while early resection was favored in region B. Thus, the treatment strategy in individual patients depended on their residential address. The inclusion criteria were histopathological diagnosis of supratentorial LGG from 1998 through 2009 in patients 18 years or older. Follow-up ended 1 January 2016. Making regional comparisons, the primary end-point was overall survival.ResultsA total of 153 patients (66 from region A, 87 from region B) were included. Early resection was carried out in 19 (29%) patients in region A compared with 75 (86%) patients in region B. Overall survival was 5.8 years (95% CI 4.5–7.2) in region A compared with 14.4 years (95% CI 10.4–18.5) in region B (P < 0.01). The effect of surgical strategy remained after adjustment for molecular markers (P = 0.001).ConclusionIn parallel population-based cohorts of LGGs, early surgical resection resulted in a clinical relevant survival benefit. The effect on survival persisted after adjustment for molecular markers.

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Section: Discussionsupporting

confidence: 51%

Surgical resection versus watchful waiting in low-grade gliomas

Jakola

Skjulsvik

Myrmel³

et al. 2017

Annals of Oncology

239

136

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“…In particular, extent of resection was found to be independent of IDH status, and thus the impact of tumor removal on survival was due to surgery per se. 10,22 As a consequence, the longterm survival in our experience in comparison with the literature could be due, at least in part, to the maximal safe surgical approach advocated by our group. 6,13,39 Third, we observed an important heterogeneity in tumor behavior in this homogeneous subset of IDH-wt AIIs, with patients who died within 3-4 years after diagnosis (in agreement with the results of previous studies on IDH-wt AII 5 ) but also in patients with extended survival.…”

Section: Discussionmentioning

confidence: 56%

Huge heterogeneity in survival in a subset of adult patients with resected, wild-type isocitrate dehydrogenase status, WHO grade II astrocytomas

Poulen¹,

Gozé

Rigau

et al. 2019

Journal of Neurosurgery

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OBJECTIVEWorld Health Organization grade II gliomas are infiltrating tumors that inexorably progress to a higher grade of malignancy. However, the time to malignant transformation is quite unpredictable at the individual patient level. A wild-type isocitrate dehydrogenase (IDH-wt) molecular profile has been reported as a poor prognostic factor, with more rapid progression and a shorter survival compared with IDH-mutant tumors. Here, the oncological outcomes of a series of adult patients with IDH-wt, diffuse, WHO grade II astrocytomas (AII) who underwent resection without early adjuvant therapy were investigated.METHODSA retrospective review of patients extracted from a prospective database who underwent resection between 2007 and 2013 for histopathologically confirmed, IDH-wt, non–1p19q codeleted AII was performed. All patients had a minimum follow-up period of 2 years. Information regarding clinical, radiographic, and surgical results and survival were collected and analyzed.RESULTSThirty-one consecutive patients (18 men and 13 women, median age 39.6 years) were included in this study. The preoperative median tumor volume was 54 cm3 (range 3.5–180 cm3). The median growth rate, measured as the velocity of diametric expansion, was 2.45 mm/year. The median residual volume after surgery was 4.2 cm3 (range 0–30 cm3) with a median volumetric extent of resection of 93.97% (8 patients had a total or supratotal resection). No patient experienced permanent neurological deficits after surgery, and all patients resumed a normal life. No immediate postoperative chemotherapy or radiation therapy was given. The median clinical follow-up duration from diagnosis was 74 months (range 27–157 months). In this follow-up period, 18 patients received delayed chemotherapy and/or radiotherapy for tumor progression. Five patients (16%) died at a median time from radiological diagnosis of 3.5 years (range 2.6–4.5 years). Survival from diagnosis was 77.27% at 5 years. None of the 21 patients with a long-term follow-up greater than 5 years have died. There were no significant differences between the clinical, radiological, or molecular characteristics of the survivors relative to the patients who died.CONCLUSIONSHuge heterogeneity in the survival data for a subset of 31 patients with resected IDH-wt AII tumors was observed. These findings suggest that IDH mutation status alone is not sufficient to predict risk of malignant transformation and survival at the individual level. Therefore, the therapeutic management of AII tumors, in particular the decision to administer early adjuvant chemotherapy and/or radiation therapy following surgery, should not solely rely on routine molecular markers.

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“…Furthermore, neurosurgeons are encouraged to continue the quest for an increased resectability of DLGG by improving surgical techniques while preserving function and quality of life at the same time29. Prediction of the attainable RTV and risk stratification at the individual level (surgeon and patient) needs to be refined to ameliorate treatment decisions363738.…”

Section: Discussionmentioning

confidence: 99%

Residual Tumor Volume as Best Outcome Predictor in Low Grade Glioma – A Nine-Years Near-Randomized Survey of Surgery vs. Biopsy

Roelz

Strohmaier

Jabbarli

et al. 2016

Sci Rep

119

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Diffuse low grade gliomas (DLGG) are continuously progressive primary brain neoplasms that lead to neurological deficits and death. Treatment strategies are controversial. Randomized trials establishing the prognostic value of surgery do not exist. Here, we report the results of a nine-year near-randomized patient distribution between resection and biopsy. Until 2012, the Department of Neurosurgery and the Department of Stereotactic Neurosurgery at the University Medical Center Freiburg were organized as separate administrative units both coordinating DLGG patient treatment independently. All consecutive adult patients with a new diagnosis of DLGG by either stereotactic biopsy or resection were included. Pre- and post-operative tumor volumetry was performed. 126 patients, 87 men (69%), 39 women (31%), median age 41 years, were included. 77 (61%) were initially managed by biopsy, 49 (39%) by resection. A significant survival benefit was found for patients with an initial management by resection (5-year OS 82% vs. 54%). The survival benefit of patients with initial resection was reserved to patients with a residual tumor volume of less than 15 cm3. Maximum safe resection is the first therapy of choice in DLGG patients if a near-complete tumor removal can be achieved. Accurate prediction of the extent-of-resection is required for selection of surgical candidates.

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A better surgical resectability of WHO grade II gliomas is independent of favorable molecular markers

Cited by 37 publications

References 37 publications

Surgical resection versus watchful waiting in low-grade gliomas

Surgical resection versus watchful waiting in low-grade gliomas

Huge heterogeneity in survival in a subset of adult patients with resected, wild-type isocitrate dehydrogenase status, WHO grade II astrocytomas

Residual Tumor Volume as Best Outcome Predictor in Low Grade Glioma – A Nine-Years Near-Randomized Survey of Surgery vs. Biopsy

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