Impact of gross total resection in patients with WHO grade III glioma harboring the IDH 1/2 mutation without the 1p/19q co-deletion

Abstract

The prognosis of patients with WHO grade III gliomas is highly dependent on their genomic status such as the isocitrate dehydrogenase (IDH) 1/2 mutation and1p/19q co-deletion. However, difficulties have been associated with determining which tumors have certain genomic profiles by preoperative radiographical modalities, and the role of surgical resection in achieving better outcomes remains unclear. This retrospective study included 124 consecutive patients with newly diagnosed grade III gliomas. The genomic status of IDH1/2 and 1p/19q was analyzed in these patients. Tumors were then divided into 3 subgroups based on their genomic status; the IDH 1/2 mutation with the 1p/19q co-deletion (1p/19q co-del), the IDH 1/2 mutation without the 1p/19q co-deletion (non-1p/19q co-del), and the IDH 1/2 wild type (IDH wt). Survival times were compared between patients who underwent gross total resection and those who did not (GTR versus non-GTR). The relationships between genomic statuses and MR imaging characteristics such as ring-like or nodular enhancements by gadolinium, and very low intensity on T1-weighted images with blurry enhancements (T1VL) were also examined. Among all patients with grade III gliomas, GTR patients had longer median survival and progression-free times than those of non-GTR patients (undefined versus 87 months, p = 0.097, and 124 versus 34 months, p = 0.059, respectively). No significant differences were observed in survival between GTR and non-GTR patients in the 1p/19q co-del group (p = 0.14), or between GTR and non-GTR patients in the IDH wt group (26 and 27 months, p = 0.29). On the other hand, in non-1p/19q co-del group, survival was significantly longer in GTR patients than in non-GTR patients (undefined versus 77 months, p = 0.005). Radiographically, T1VL was detected in most tumors in the non-1p/19q co-del group (78.2 %), but only 6 (21.4 %) and 17 (41.5 %) tumors in the 1p/19q co-del and IDH wt groups, respectively. A correlation was not found between other genomic subgroups and MR imaging findings. Strict surgical removal is important to improve the prognosis of patients with grade III gliomas, especially for tumors with the IDH 1/2 mutation without the 1p/19q co-deletion. The MR finding of T1VL can be used to select candidates for more radical resection.

Differential expression of the TWEAK receptor Fn14 in IDH1 wild-type and mutant gliomas

“…One of these differentially adapted processes is tumor cell invasion. IDH mutated tumors have more discrete imaging patterns, intraoperative borders, and histological margins [46, 47]. We report here that expression of the pro-invasive receptor Fn14 is lower in GBM tumors carrying the IDH1 gene mutation compared to those with an IDH1 WT gene.…”

Aptamer-conjugated PEGylated quantum dots targeting epidermal growth factor receptor variant III for fluorescence imaging of glioma

“…Surgical resection is crucial to improve the prognosis of patients with low-or high-grade gliomas, [3][4][5][6] and hence, maximum safe resection becomes tremendously important. However, it is difficult to resect low-and high-grade gliomas due to their propensity to infiltrate deep into surrounding parenchyma.…”

“…2 Surgical resection is the most effective therapy for glioma patients, and maximum safe resection is crucial to improve the prognosis of patients with low-or high-grade gliomas. [3][4][5][6] However, balancing maximum cytoreduction with preservation of normal brain tissue is complicated due to the infiltrative nature of the tumors. Over 90% of recurrent tumors develop within a 2-3 cm margin of the primary site and are thought to arise from microscopic glioma cells that infiltrate the area surrounding the original…”

Reflecting on survivorship outcomes to aid initial decision making in patients treated for IDH‐mutated anaplastic glioma

“…10 Although the timing of the intervention remains uncertain, especially for patients with 1p19q codeleted tumors, the general conclusion has been for more aggressive combined adjuvant therapies to be performed earlier in the natural history of the tumor. 8,11,12 Therefore, the objective of the current study was to review the survivorship outcomes in a population of patients with IDH-mutated anaplastic glioma to determine the level of long-term functioning after management with RT and chemotherapy and examine those factors that may impact later adverse effects. 8,11,12 Therefore, the objective of the current study was to review the survivorship outcomes in a population of patients with IDH-mutated anaplastic glioma to determine the level of long-term functioning after management with RT and chemotherapy and examine those factors that may impact later adverse effects.…”

“…Knowledge of IDH mutation status now provides further prognostic information, but there remains uncertainty regarding management decisions including extent of surgical resection and timing of RT or chemotherapy. 8,11,12 Therefore, the objective of the current study was to review the survivorship outcomes in a population of patients with IDH-mutated anaplastic glioma to determine the level of long-term functioning after management with RT and chemotherapy and examine those factors that may impact later adverse effects.…”