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Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection.
Neurosurg Focus 2015; 38(1):E7NF

Abstract

OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status.

METHODS

One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy.

RESULTS

Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS.

CONCLUSIONS

The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection.

Authors+Show Affiliations

Department of Neurosurgery;No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25599276

Citation

Nitta, Masayuki, et al. "Proposed Therapeutic Strategy for Adult Low-grade Glioma Based On Aggressive Tumor Resection." Neurosurgical Focus, vol. 38, no. 1, 2015, pp. E7.
Nitta M, Muragaki Y, Maruyama T, et al. Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection. Neurosurg Focus. 2015;38(1):E7.
Nitta, M., Muragaki, Y., Maruyama, T., Ikuta, S., Komori, T., Maebayashi, K., ... Okada, Y. (2015). Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection. Neurosurgical Focus, 38(1), pp. E7. doi:10.3171/2014.10.FOCUS14651.
Nitta M, et al. Proposed Therapeutic Strategy for Adult Low-grade Glioma Based On Aggressive Tumor Resection. Neurosurg Focus. 2015;38(1):E7. PubMed PMID: 25599276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection. AU - Nitta,Masayuki, AU - Muragaki,Yoshihiro, AU - Maruyama,Takashi, AU - Ikuta,Soko, AU - Komori,Takashi, AU - Maebayashi,Katsuya, AU - Iseki,Hiroshi, AU - Tamura,Manabu, AU - Saito,Taiichi, AU - Okamoto,Saori, AU - Chernov,Mikhail, AU - Hayashi,Motohiro, AU - Okada,Yoshikazu, PY - 2015/1/20/entrez PY - 2015/1/20/pubmed PY - 2015/9/19/medline KW - ACNU = nimustine hydrochloride KW - EOR = extent of resection KW - EORTC = European Organisation for Research and Treatment of Cancer KW - LGG = low-grade glioma KW - OS = overall survival KW - PCV = procarbazine, lomustine, vincristine KW - PFS = progression-free survival KW - RT = radiotherapy KW - low-grade glioma KW - surgical resection KW - survival KW - therapeutic strategy KW - tumor subtype SP - E7 EP - E7 JF - Neurosurgical focus JO - Neurosurg Focus VL - 38 IS - 1 N2 - OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status. METHODS One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy. RESULTS Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS. CONCLUSIONS The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/25599276/Proposed_therapeutic_strategy_for_adult_low_grade_glioma_based_on_aggressive_tumor_resection_ L2 - https://thejns.org/doi/10.3171/2014.10.FOCUS14651 DB - PRIME DP - Unbound Medicine ER -