Evidence for a Clinically Distinct New Subtype of Grade II Astrocytomas in Patients with Long-term Epilepsy

Schramm, Johannes; Luyken, Cordelia; Urbach, Horst; Fimmers, Rudolf; Blümcke, Ingmar

doi:10.1227/01.neu.0000129546.38675.1b

Cited by 64 publications

(37 citation statements)

References 18 publications

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“…8,12 Some authors have suggested that this phenomenon is related to different tumor histopathological characteristics. 16 However, this phenomenon may reflect a selection bias, because chronic epilepsy lasting for years without significant disease progression is de facto evidence of a slowly growing benign lesion. Patient age is a more reliable prognostic factor in neurooncology.…”

Section: Discussionmentioning

confidence: 99%

Brain tumors in the mesial temporal lobe: long-term oncological outcome

Chung¹

2009

FOC

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Object Surgical treatment of brain tumors in the mesial temporal lobe (MTL) is a highly demanding procedure. Only a few studies describing the surgery of MTL tumors have been reported, and they have been focused on the operative techniques and immediate results of the surgery. The authors have analyzed the long-term oncological outcome in patients with MTL tumors. Methods Thirty-six patients with an MTL tumor were studied. The mean patient age at surgery was 32 years (range 13–62 years). The tumors were confined to the MTL (Schramm Type A) in 25 patients (69%). Extension of the tumor into the fusiform gyrus (Schramm Type C) and temporal stem (Schramm Type D) was observed in 4 and 7 patients (11 and 19%), respectively. There was a significant difference in the tumor size according to Schramm types (p = 0.001). Complete tumor resection was achieved in 26 patients (72%). All tumors were low-grade lesions except for 1 anaplastic astrocytoma. Results After a median follow-up period of 50.5 months, 7 patients showed progression of the disease. The actuarial progression-free survival rates were 97% in the 1st year, 84% in the 2nd year, and 80% in the 5th year. The degree of tumor resection was significantly related to the tumor control failure (p < 0.001) and malignant transformation of a low-grade tumor (p < 0.001). Univariate analyses using a Cox proportional hazards model showed that the following factors were significantly associated with a failure to control the tumor: 1) extent of the tumor (Schramm Type D; p = 0.003, relative risk [RR] 12.04); 2) size of the tumor (p = 0.033, RR 1.052/mm); 3) patient age at surgery ≥ 50 years (p = 0.007, RR 8.312); and 4) short duration of epilepsy (< 6 months; p = 0.001, RR 21.54). Conclusions Surgery is the principal treatment for MTL tumors, despite its technical difficulty. Complete tumor resection is strongly recommended for long-term tumor control. The MTL tumors are heterogeneous in their prognosis. Older age, short duration of epilepsy, and tumor size are all associated with poor outcome. Patients with these characteristics may have a more aggressive form of the disease than those with MTL tumors associated with chronic epilepsy.

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Section: Discussionmentioning

confidence: 99%

Brain tumors in the mesial temporal lobe: long-term oncological outcome

Chung¹

2009

FOC

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“…Moreover, a patient died of relentless recurrence and malignant transformation of low-grade ganglioglioma after intended subtotal resection for protection of memory function. Although it has been proposed that brain tumors presenting with chronic epilepsy are biologically indolent, 4,15 to the best of our knowledge, the prognosis cannot yet be predicted on a patient basis, and total tumor removal has an important meaning in the oncological perspective.…”

Section: 10mentioning

confidence: 99%

Long‐term surgical outcomes of temporal lobe epilepsy associated with low‐grade brain tumors

Phi

Kim

Cho

et al. 2009

Cancer

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“…Following resection of the tumour, 82% of the group of 60 patients studied were seizure-free after one year. A similar group, consisting typically of low grade gliomas, has been studied more recently [124] and characterized by a low cellularity, lack of mitoses and the absence of certain protein expression, such as the microtubule-associated protein (MAP2) which is critical in neurogenesis. The protein stabilizes microtubules that are enriched in dendrites, implicating a role in stabilizing dendritic shape during neuronal development.…”

Section: Surgerymentioning

confidence: 99%

Glioma-Associated Epilepsy

Elisevich¹

2013

Clinical Management and Evolving Novel Therapeutic Strategies for Patients With Brain Tumors

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Evidence for a Clinically Distinct New Subtype of Grade II Astrocytomas in Patients with Long-term Epilepsy

Cited by 64 publications

References 18 publications

Brain tumors in the mesial temporal lobe: long-term oncological outcome

Brain tumors in the mesial temporal lobe: long-term oncological outcome

Long‐term surgical outcomes of temporal lobe epilepsy associated with low‐grade brain tumors

Glioma-Associated Epilepsy

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