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Adult Low-grade Glioma

19-year Experience at a Single Institution

Youland, Ryan S., BS*; Brown, Paul D., MD; Giannini, Caterina, MD, PhD; Parney, Ian F., MD, PhD§; Uhm, Joon H., MD; Laack, Nadia N., MD

American Journal of Clinical Oncology: December 2013 - Volume 36 - Issue 6 - p 612–619
doi: 10.1097/COC.0b013e31825d580a
Original Articles: Central Nervous System
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Objectives: To determine prognostic factors and optimal timing of postoperative radiation therapy (RT) in adult low-grade gliomas.

Methods: Records from 554 adults diagnosed with nonpilocytic low-grade gliomas at Mayo Clinic between 1992 and 2011 were retrospectively reviewed.

Results: Median follow-up was 5.2 years. Histology revealed astrocytoma in 22%, oligoastrocytoma in 34%, and oligodendroglioma in 45%. Initial surgery achieved gross total resection in 31%, radical subtotal resection in 10%, subtotal resection (STR) in 21%, and biopsy only in 39%. Median overall survival (OS) and progression-free survival (PFS) were 11.4 and 4.1 years, respectively. On multivariate analysis, factors associated with lower OS included astrocytomas and use of postoperative RT. Adverse prognostic factors for PFS on multivariate analysis included tumor size, astrocytomas, STR/biopsy only and not receiving RT. Patients undergoing gross total resection/radical subtotal resection had the best OS and PFS. Comparing survival with the log-rank test demonstrated no association between RT and PFS (P=0.24), but RT was associated with lower OS (P<0.0001). In patients undergoing STR/biopsy only, RT was associated with improved PFS (P<0.0001) but lower OS (P=0.03). Postoperative RT was associated with adverse prognostic factors including age > 40 years, deep tumors, size≥5 cm, astrocytomas and STR/biopsy only. Patients delaying RT until recurrence experienced 10-year OS (71%) similar to patients never needing RT (74%; P=0.34).

Conclusions: This study supports the association between aggressive surgical resection and better OS and PFS, and between postoperative RT and improved PFS in patients receiving STR/biopsy only. In addition, our findings suggest that delaying RT until progression is safe in patients who are eligible.

*College of Medicine

Departments of Pathology

§Neurosurgery

Neurology

Radiation Oncology, Mayo Clinic, Rochester, MN

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

The authors declare no conflicts of interest.

Reprints: Nadia N. Laack, MD, Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: laack.nadia@mayo.edu.

© 2013 by Lippincott Williams & Wilkins, Inc