Oligodendroglioma resection: a Surveillance, Epidemiology, and End Results (SEER) analysis

Abstract

OBJECTIVE The available evidence suggests that the clinical benefits of extended resection are limited for chemosensitive tumors, such as primary CNS lymphoma. Oligodendroglioma is generally believed to be more sensitive to chemotherapy than astrocytoma of comparable grades. In this study the authors compare the survival benefit of gross-total resection (GTR) in patients with oligodendroglioma relative to patients with astrocytoma. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) Program (1999-2010) database, the authors identified 2378 patients with WHO Grade II oligodendroglioma (O2 group) and 1028 patients with WHO Grade III oligodendroglioma (O3 group). Resection was defined as GTR, subtotal resection, biopsy only, or no resection. Kaplan-Meier and multivariate Cox regression survival analyses were used to assess survival with respect to extent of resection. RESULTS Cox multivariate analysis revealed that the hazard of dying from O2 and O3 was comparable between patients who underwent biopsy only and GTR (O2: hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.73-1.53; O3: HR 1.18, 95% CI 0.80-1.72). A comprehensive search of the published literature identified 8 articles without compelling evidence that GTR is associated with improved overall survival in patients with oligodendroglioma. CONCLUSIONS This SEER-based analysis and review of the literature suggest that GTR is not associated with improved survival in patients with oligodendroglioma. This finding contrasts with the documented association between GTR and overall survival in anaplastic astrocytoma and glioblastoma. The authors suggest that this difference may reflect the sensitivity of oligodendroglioma to chemotherapy as compared with astrocytomas.

Real-World Impact of Surgical Excision on Overall Survival in Primary Central Nervous System Lymphoma

“…Stereotactic needle biopsy for diagnosis followed by systemic high-dose methotrexate-based chemotherapy is the current management paradigm for patients with PCNSL (9,10). Considering exquisite sensitivity to chemotherapy and the risk of postoperative morbidity in these patients, surgery is reported to play a limited role in PCNSL compared to the management of other intracranial tumors, like diffuse gliomas (11)(12)(13)(14). However, the widely adopted opinion of discouragement of surgery is based on some out-of-date retrospective studies with small samples (15)(16)(17)(18)(19)(20)(21).…”

Region-by-region analysis of PET, MRI, and histology in en bloc-resected oligodendrogliomas reveals intra-tumoral heterogeneity

“…Primary treatment is maximal safe resection, followed by radiotherapy and chemotherapy for highrisk patients [4,5]. Based on their chemosensitivity, it has recently been suggested that chemotherapy may be the optimal primary treatment for oligodendrogliomas [6].…”

Multicentric Registry Study on Epidemiological and Biological Disease Profile as Well as Clinical Outcome in Patients with Low-Grade Gliomas: The LoG-Glio Project

“…The recently published SEER data on the association of GTR with improved survival in oligodendroglioma surprisingly showed no effect of surgery. 38 This finding might be due to the good sensitivity to chemotherapy with this diagnosis. However, despite the limitation of the missing molecular pathologic data like 1p19q codeletion, there is also a strong limitation based on the subjective assessment of EoR by the surgeons that is known to be usually overrated.…”