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16.10.2019 | Clinical Study

Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification

verfasst von: Elena Jansen, Christina Hamisch, Daniel Ruess, Dieter Henrik Heiland, Roland Goldbrunner, Maximilian I. Ruge, Oliver Schnell, Stefan J. Grau

Erschienen in: Journal of Neuro-Oncology | Ausgabe 3/2019

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Abstract

Purpose

To provide detailed long-term data after initial observation for patients after histological confirmation of low grade (WHO II) gliomas according to molecular stratification.

Methods

A series of 110 patients with watchful waiting strategy after initial surgery for LGG and re-surgery at tumor progression were analyzed. Progression-free survival, time to malignant transformation, post-recurrence survival, and overall survival were estimated with the Kaplan–Meier method. Prognostic factors were identified by the Log Rank test and Cox multivariate proportional hazards model.

Results

The cohort comprised 18 IDH wild type (IDH^wt) and 53 IDH mutated (IDH^mut) astrocytomas, and 39 IDH mutated and 1p 19q co-deleted (IDH^mut/codel) patients. The median follow-up was 126 (95% CI 109–143) months. Surgery was gross total resection in 58, subtotal resection in 28, and biopsy in 24 patients. Progression-free survival rates at 5, 10 and 15 years was 38% 18% and 1%. The corresponding malignant transformation rates were 17%, 39% and 71%.

The initial extent of resection influenced progression-free survival, time to malignant transformation and overall survival. Molecular subtype IDH^mut/codel was the strongest prognostic factor for overall survival and for time to malignant transformation.

Conclusion

The strongest determinant of the patients’ course after initial watchful waiting was the molecular tumor status. Extensive resection may increase time to progression and malignant transformation. Observation may be justified in selected patients.

Buckner JC, Shaw EG, Pugh SL et al (2016) Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 374:1344–1355. https://doi.org/10.1056/NEJMoa1500925 CrossRefPubMedPubMedCentral

Leighton C, Fisher B, Bauman G et al (1997) Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 15:1294–1301. https://doi.org/10.1200/JCO.1997.15.4.1294 CrossRefPubMed

Chaichana KL, McGirt MJ, Laterra J et al (2010) Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas. J Neurosurg 112:10–17. https://doi.org/10.3171/2008.10.JNS08608 CrossRefPubMed

Schmidt MH, Berger MS, Lamborn KR et al (2003) Repeated operations for infiltrative low-grade gliomas without intervening therapy. J Neurosurg 98:1165–1169. https://doi.org/10.3171/jns.2003.98.6.1165 CrossRefPubMed

Soffietti R, Baumert BG, Bello L et al (2010) Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force. Eur J Neurol 17:1124–1133. https://doi.org/10.1111/j.1468-1331.2010.03151.x CrossRefPubMed

Sanai N, Chang S, Berger MS (2011) Low-grade gliomas in adults. J Neurosurg 115:948–965. https://doi.org/10.3171/2011.7.JNS101238 CrossRefPubMed

Schiff D, Brown PD, Giannini C (2007) Outcome in adult low-grade glioma: the impact of prognostic factors and treatment. Neurology 69:1366–1373. https://doi.org/10.1212/01.wnl.0000277271.47601.a1 CrossRefPubMed

Coburger J, Merkel A, Scherer M et al (2016) Low-grade glioma surgery in intraoperative magnetic resonance imaging. Neurosurgery 78:775–786. https://doi.org/10.1227/NEU.0000000000001081 CrossRefPubMed

Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131:803–820. https://doi.org/10.1007/s00401-016-1545-1 CrossRefPubMed

10.

Youland RS, Kreofsky CR, Schomas DA et al (2017) The impact of adjuvant therapy for patients with high-risk diffuse WHO grade II glioma. J Neurooncol 135:535–543. https://doi.org/10.1007/s11060-017-2599-1 CrossRefPubMed

11.

Shaw EG, Wang M, Coons SW et al (2012) Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802. J Clin Oncol 30:3065–3070. https://doi.org/10.1200/JCO.2011.35.8598 CrossRefPubMedCentralPubMed

12.

Johnson BE, Mazor T, Hong C et al (2014) Mutational analysis reveals the origin and therapy-driven evolution of recurrent glioma. Science 343(80):189–193. https://doi.org/10.1126/science.1239947 CrossRefPubMed

13.

Murphy ES, Leyrer CM, Parsons M et al (2018) Risk factors for malignant transformation of low-grade glioma. Int J Radiat Oncol Biol Phys 100:965–971. https://doi.org/10.1016/j.ijrobp.2017.12.258 CrossRefPubMed

14.

Hunter C, Smith R, Cahill DP et al (2006) A hypermutation phenotype and somatic MSH6 mutations in recurrent human malignant gliomas after alkylator chemotherapy. Cancer Res 66:3987–3991. https://doi.org/10.1158/0008-5472.CAN-06-0127 CrossRefPubMedPubMedCentral

15.

Weller M, van den Bent M, Tonn JC et al (2017) European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas. Lancet Oncol 18:e315–e329. https://doi.org/10.1016/S1470-2045(17)30194-8 CrossRefPubMed

16.

Grau SJ, Hampl JA, Kohl A-C et al (2017) Impact of resection on survival of isocitrate dehydrogenase 1-mutated world health organization grade II astrocytoma after malignant progression. World Neurosurg 103:180–185. https://doi.org/10.1016/j.wneu.2017.03.123 CrossRefPubMed

17.

Jakola AS, Myrmel KS, Kloster R et al (2012) Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 308:1881–1888. https://doi.org/10.1001/jama.2012.12807 CrossRefPubMed

18.

van den Bent MJ, Brandes AA, Taphoorn MJB et al (2013) Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 31:344–350. https://doi.org/10.1200/JCO.2012.43.2229 CrossRefPubMed

19.

van den Bent MJ, Afra D, de Witte O et al (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366:985–990. https://doi.org/10.1016/S0140-6736(05)67070-5 CrossRefPubMed

20.

Cairncross G, Wang M, Shaw E et al (2013) Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 31:337–343. https://doi.org/10.1200/JCO.2012.43.2674 CrossRefPubMed

21.

Smith JS, Chang EF, Lamborn KR et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345. https://doi.org/10.1200/JCO.2007.13.9337 CrossRefPubMed

22.

Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62:753–766. https://doi.org/10.1227/01.neu.0000318159.21731.cf CrossRefPubMed

23.

Capelle L, Fontaine D, Mandonnet E et al (2013) Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg 118:1157–1168. https://doi.org/10.3171/2013.1.JNS121 CrossRefPubMed

24.

Majchrzak K, Kaspera W, Bobek-Billewicz B et al (2012) The assessment of prognostic factors in surgical treatment of low-grade gliomas: a prospective study. Clin Neurol Neurosurg 114:1135–1144. https://doi.org/10.1016/j.clineuro.2012.02.054 CrossRefPubMed

25.

Kreth FW, Faist M, Grau S, Ostertag CB (2006) Interstitial 125I radiosurgery of supratentorial de novo WHO Grade 2 astrocytoma and oligoastrocytoma in adults: long-term results and prognostic factors. Cancer 106:1372–1381. https://doi.org/10.1002/cncr.21750 CrossRefPubMed

26.

Tom MC, Varra V, Leyrer CM et al (2019) Risk factors for progression among low-grade gliomas after gross total resection and initial observation in the molecular era. Int J Radiat Oncol 104:1099–1105. https://doi.org/10.1016/j.ijrobp.2019.04.010 CrossRef

27.

Shaw EG, Berkey B, Coons SW et al (2008) Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. J Neurosurg 109:835–841. https://doi.org/10.3171/JNS/2008/109/11/0835 CrossRefPubMed

28.

Lin AL, White M, Miller-Thomas MM et al (2016) Molecular and histologic characteristics of pseudoprogression in diffuse gliomas. J Neurooncol 130:529–533. https://doi.org/10.1007/s11060-016-2247-1 CrossRefPubMedPubMedCentral

29.

Cancer Genome Atlas Research Network, Brat DJ, Verhaak RGW et al (2015) Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med 372:2481–2498. https://doi.org/10.1056/NEJMoa1402121 CrossRef

30.

Weller M, Weber RG, Willscher E et al (2015) Molecular classification of diffuse cerebral WHO grade II/III gliomas using genome- and transcriptome-wide profiling improves stratification of prognostically distinct patient groups. Acta Neuropathol 129:679–693. https://doi.org/10.1007/s00401-015-1409-0 CrossRefPubMed

31.

Jung T-Y, Jung S, Moon J-H et al (2011) Early prognostic factors related to progression and malignant transformation of low-grade gliomas. Clin Neurol Neurosurg 113:752–757. https://doi.org/10.1016/j.clineuro.2011.08.002 CrossRefPubMed

32.

Baumert BG, Hegi ME, van den Bent MJ et al (2016) Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033–26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 17:1521–1532. https://doi.org/10.1016/S1470-2045(16)30313-8 CrossRefPubMedPubMedCentral

33.

Aibaidula A, Chan AK-Y, Shi Z et al (2017) Adult IDH wild-type lower-grade gliomas should be further stratified. Neuro Oncol 19:1327–1337. https://doi.org/10.1093/neuonc/nox078 CrossRefPubMedPubMedCentral

Titel: Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification
verfasst von: Elena Jansen
Christina Hamisch
Daniel Ruess
Dieter Henrik Heiland
Roland Goldbrunner
Maximilian I. Ruge
Oliver Schnell
Stefan J. Grau
Publikationsdatum: 16.10.2019
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 3/2019
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-019-03316-7

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