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22.11.2018 | Clinical Study

Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system

verfasst von: Daniel Delev, Dieter Henrik Heiland, Pamela Franco, Peter Reinacher, Irina Mader, Ori Staszewski, Silke Lassmann, Stefan Grau, Oliver Schnell

Erschienen in: Journal of Neuro-Oncology | Ausgabe 1/2019

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Abstract

Purpose

According to the 2016 WHO classification lower-grade gliomas consist of three groups: IDH-mutated and 1p/19q co-deleted, IDH-mutated and IDH-wildtype tumors. The aim of this study was to evaluate the impact of surgical therapy for lower-grade gliomas with a particular focus on the molecular subgroups.

Methods

This is a bi-centric retrospective analysis including 299 patients, who underwent treatment for lower-grade glioma between 1990 and 2016. All tumors were re-classified according to the 2016 WHO classification. Data concerning baseline and tumor characteristics, overall survival, different treatment modalities and functional outcome were analyzed.

Results

A total of 112 (37.5%) patients with IDH-mutation and 1p/19q co-deletetion, 86 (28.8%) patients with IDH-mutation and 101 (33.8%) patients with IDH-wildtype tumors were identified. The median overall survival (mOS) differed significantly between the groups (p < 0.001). Surgical resection was performed in 226 patients and showed significantly improved mOS compared to the biopsy group (p = 0.001). Gross total resection (GTR) was associated with better survival (p = 0.007) in the whole cohort as well as in the IDH-mutated and IDH-wildtype groups compared to partial resection or biopsy. IDH-wildtype patients presented a significant survival benefit after combined radio-chemotherapy compared to radio- or chemotherapy alone (p = 0.02). Good clinical status (NANO) was associated with longer OS (p = 0.001).

Conclusion

The impact of surgical treatment on the outcome of lower-grade gliomas depends to a great extent on the molecular subtype of the tumors. Patients with more aggressive tumors (IDH-wildtype) seem to profit from more intensive treatment like GTR, multiple resections and combined radio-/chemotherapy.

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Titel: Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system
verfasst von: Daniel Delev
Dieter Henrik Heiland
Pamela Franco
Peter Reinacher
Irina Mader
Ori Staszewski
Silke Lassmann
Stefan Grau
Oliver Schnell
Publikationsdatum: 22.11.2018
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 1/2019
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-03030-w

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Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system

Abstract

Purpose

Methods

Results

Conclusion

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Abstract

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