Adult Low-grade Glioma

Youland, Ryan S.; Brown, Paul D.; Giannini, Caterina; Parney, Ian F.; Uhm, Joon H.; Laack, Nadia N.

doi:10.1097/coc.0b013e31825d580a

Cited by 39 publications

(7 citation statements)

References 29 publications

(52 reference statements)

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“…The study finds an estimated Kaplan-Meier OS close to 16 years. This OS estimation is better than an older retrospective series reported in the early 2000s with an estimated median OS at 6.4 years (14) or some more recent studies (15)(16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 51%

Adult Diffuse Low-Grade Gliomas: 35-Year Experience at the Nancy France Neurooncology Unit

et al. 2020

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Background: To report survival, spontaneous prognostic factors, and treatment efficacy in a French monocentric cohort of diffuse low-grade glioma (DLGG) patients over 35 years of follow-up.Methods: A monocentric retrospective study of 339 patients diagnosed with a new DLGG between 01/01/1982 and 01/01/2017 was created. Inclusion criteria were patient age ≥18 years at diagnosis and histological diagnosis of WHO grade II glioma (according to 1993(according to , 2007(according to , and 2016. The survival parameters were estimated using the Kaplan-Meier method with a 95% confidence interval. Differences in survival were tested for statistical significance by the log-rank test. Factors were considered significant when p ≤ 0.1 and p ≤ 0.05 in the univariate and multivariate analyses, respectively.Results: A total of 339 patients were included with a median follow-up of 8.7 years. The Kaplan-Meier median overall survival was 15.7 years. At the time of radiological diagnosis, Karnofsky Performance Status score and initial tumor volume were significant independent prognostic factors. Oncological prognostic factors were the extent of resection for patients who underwent surgery and the timing of radiotherapy for those concerned. In this study, patients who had delayed radiotherapy (provided remaining low grade) did not have worse survival compared with patients who had early radiotherapy.

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Section: Discussionmentioning

confidence: 51%

Adult Diffuse Low-Grade Gliomas: 35-Year Experience at the Nancy France Neurooncology Unit

et al. 2020

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“…found similar results in a nonrandomized trial[ 31 ], reporting equivalent outcomes in patients who underwent surgery alone versus those who received adjuvant chemotherapy. The benefits of surgery with maximal safe resection are established[ 32 ]. Our study with over 70% receiving surgery as first course of treatment demonstrates the benefit of this and is in keeping with the literature, as surgical resection and the extent of the resection has a significant survival benefit[ 33 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive evaluation of treatment and outcomes of low-grade diffuse gliomas

et al. 2018

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BackgroundLow-grade gliomas affect younger adults and carry a favorable prognosis. They include a variety of biological features affecting clinical behavior and treatment. Having no guidelines on treatment established, we aim to describe clinical and treatment patterns of low-grade gliomas across the largest cancer database in the United States.MethodsWe analyzed the National Cancer Database from 2004 to 2015, for adult patients with a diagnosis of World Health Organization grade II diffuse glioma.ResultsWe analyzed 13,621 cases with median age of 41 years. Over 56% were male, 88.4% were white, 6.1% were black, and 7.6% Hispanic. The most common primary site location was the cerebrum (79.9%). Overall, 72.2% received surgery, 36.0% radiation, and 27.3% chemotherapy. Treatment combinations included surgery only (41.5%), chemotherapy + surgery (6.6%), chemotherapy only (3.1%), radiation + chemotherapy + surgery (10.7%), radiation + surgery (11.5%), radiation only (6.1%), and radiotherapy + chemotherapy (6.7%). Radiation was more common in treatment of elderly patients, 1p/19q co-deletion (37.3% versus 24.3%, p<0.01), and tumors with midline location. Median survival was 11 years with younger age, 1p/19q co-deletion, and cerebrum location offered survival advantage.ConclusionsTumor location, 1p/19q co-deletion, and age were the main determinants of treatment received and survival, likely reflecting tumor biology differences. Any form of treatment was preferred over watchful waiting in the majority of the patients (86.1% versus 8.1%). Survival of low-grade gliomas is higher than previously reported in the majority of clinical trials and population-based analyses. Our analysis provides a real world estimation of treatment decisions, use of molecular data, and outcomes.

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“…The PFS of patients with LGGs is lengthened; however, the optimal timing for receiving EBRT remains debatable ( 21 , 22 ). Based on 19 years of experience, Youland et al ( 23 ) suggested that immediate postoperative EBRT should be implemented only for high-risk patients. It appears to be safe to delay EBRT in those patients in which it is possible to do so ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…Based on 19 years of experience, Youland et al ( 23 ) suggested that immediate postoperative EBRT should be implemented only for high-risk patients. It appears to be safe to delay EBRT in those patients in which it is possible to do so ( 23 ). A recent retrospective study revealed that upfront radiation was associated with an improvement in the PFS (time) of patients with LGGs, but also with a significantly decreased OS (time) and an increased rate of malignant degeneration ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Management of supratentorial recurrent low-grade glioma: A multidisciplinary experience in 35 adult patients

et al. 2017

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The management of recurrent diffuse low-grade gliomas (LGGs) is controversial. In the present study, the multidisciplinary management of 35 patients with recurrent LGGs was retrospectively analyzed. Tumor progression or recurrence was defined by clinical, radiological and/or metabolic pejorative evolution. All patients were regularly followed up by a multidisciplinary neuro-oncological group at Hôpital Erasme. Patients with histologically confirmed supratentorial LGGs (7 astrocytoma, 22 oligodendrogliomas and 6 oligoastrocytomas) who had undergone surgery between August 2004 and November 2010 were included. A total of 3 patients exhibited no tumor progression (median follow-up (FU), 81 months; range, 68–108 months). Tumor recurrence occurred in the 32 remaining patients [progression-free survival (PFS), 26 months; range, 2–104 months]. In addition, 25/29 (86%) patients who received surgery alone underwent reoperation at the time of tumor recurrence, and high-grade transformation occurred in 6 of these patients (24%). Furthermore, 4/29 (14%) patients were treated with adjuvant therapy alone (3 chemotherapy and 1 radiotherapy). In the 19 patients with no high-grade transformation at reintervention, 3 received adjuvant therapy and 16 were regularly followed up through multimodal imaging. The PFS time of the patients who underwent reoperation with close FU (n=16) and for the patients receiving adjuvant therapy with or without surgery (n=7) at first recurrence was 10 and 24 months (P=0.005), respectively. However, no significant difference was observed for overall survival (P=0.403). At the time of this study, 22 of the 35 patients included were alive following a median FU time of 109 months (range, 55–136). The results of the present study could change the multidisciplinary approach used into a more aggressive approach with adjuvant therapy, with or without surgery, for the treatment of a select subpopulation of patients with LGGs at the first instance of tumor recurrence.

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Adult Low-grade Glioma

Cited by 39 publications

References 29 publications

Adult Diffuse Low-Grade Gliomas: 35-Year Experience at the Nancy France Neurooncology Unit

Adult Diffuse Low-Grade Gliomas: 35-Year Experience at the Nancy France Neurooncology Unit

Comprehensive evaluation of treatment and outcomes of low-grade diffuse gliomas

Management of supratentorial recurrent low-grade glioma: A multidisciplinary experience in 35 adult patients

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