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

Roelz, Roland; Strohmaier, David; Jabbarli, Ramazan; Kraeutle, Rainer; Egger, Karl; Coenen, Volker A.; Weyerbrock, Astrid; Reinacher, Peter C.

doi:10.1038/srep32286

Cited by 119 publications

(65 citation statements)

References 41 publications

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“…Since the existing literature is a mix of progression and transformation, the numbers would likely differ even 19 (44) more between astrocytomas and oligodendrogliomas if only malignant transformation was analyzed. In the surgical literature several studies have reported that remnant less than 10-15 ml have a better prognosis [36,37] although no visible postoperative remnant is clearly superior [38][39][40]. In our series, smaller residual tumor volumes than 10 ml did not protect against transformation although it was seen in only 7% of cases.…”

Section: Tumor Burdencontrasting

confidence: 53%

Spatial distribution of malignant transformation in patients with low-grade glioma

et al. 2020

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Background Malignant transformation represents the natural evolution of diffuse low-grade gliomas (LGG). This is a catastrophic event, causing neurocognitive symptoms, intensified treatment and premature death. However, little is known concerning the spatial distribution of malignant transformation in patients with LGG. Materials and methods Patients histopathological diagnosed with LGG and subsequent radiological malignant transformation were identified from two different institutions. We evaluated the spatial distribution of malignant transformation with (1) visual inspection and (2) segmentations of longitudinal tumor volumes. In (1) a radiological transformation site < 2 cm from the tumor on preceding MRI was defined local transformation. In (2) overlap with pretreatment volume after importation into a common space was defined as local transformation. With a centroid model we explored if there were particular patterns of transformations within relevant subgroups. Results We included 43 patients in the clinical evaluation, and 36 patients had MRIs scans available for longitudinal segmentations. Prior to malignant transformation, residual radiological tumor volumes were > 10 ml in 93% of patients. The transformation site was considered local in 91% of patients by clinical assessment. Patients treated with radiotherapy prior to transformation had somewhat lower rate of local transformations (83%). Based upon the segmentations, the transformation was local in 92%. We did not observe any particular pattern of transformations in examined molecular subgroups. Conclusion Malignant transformation occurs locally and within the T2w hyperintensities in most patients. Although LGG is an infiltrating disease, this data conceptually strengthens the role of loco-regional treatments in patients with LGG.

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Section: Tumor Burdencontrasting

confidence: 53%

Spatial distribution of malignant transformation in patients with low-grade glioma

et al. 2020

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“…Another criticism we faced was that the cohort from region A did so poorly that they could not be representative for a LGG cohort, but this speculation is refuted after molecular classification. In fact, survival in region A compares well to historical Surveillance, Epidemiology, and End Results (SEER) data from the years before extensive surgery was as often attempted or achieved and from other studies studying biopsies as a surgical policy [ 22 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 73%

“…Retrospective uncontrolled studies report a clear advantage with radiological complete resection, although often not achievable [ 3 , 4 , 21 ]. Others have emphasized that a residual tumor volume <15 ml must be achieved to have a beneficial survival effect [ 22 ]. However, extent of resection is not random and selection bias may clearly be an issue in such studies.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection versus watchful waiting in low-grade gliomas

Jakola

Skjulsvik

Myrmel³

et al. 2017

Annals of Oncology

239

156

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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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“…We identified 1 subgroup of 5 patients who underwent subtotal resection and died rapidly-that is, at a median time from radiological diagnosis of 3.5 years-while OS in patients with WHO grade II gliomas who benefited from early (sub)total resection was 14-15 years in recent surgical series. 6,22,29,34 However, in a second subgroup, none of the 21 patients with a long-term followup over 5 years died (including 2 patients who underwent surgery more than 10 years ago). Thus, the 5-year survival rate is 77.27%.…”

Section: Discussionmentioning

confidence: 99%

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

Cited by 119 publications

References 41 publications

Spatial distribution of malignant transformation in patients with low-grade glioma

Spatial distribution of malignant transformation in patients with low-grade glioma

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

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