TY - JOUR
T1 - Adult low-grade glioma
T2 - 19-year experience at a single institution
AU - Youland, Ryan S.
AU - Brown, Paul D.
AU - Giannini, Caterina
AU - Parney, Ian F.
AU - Uhm, Joon H.
AU - Laack, Nadia N.
PY - 2013/12
Y1 - 2013/12
N2 - 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 lowgrade 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).
AB - 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 lowgrade 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).
KW - Clinical outcomes
KW - Low-grade glioma
KW - Prognosis
KW - Radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=84892568666&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892568666&partnerID=8YFLogxK
U2 - 10.1097/COC.0b013e31825d580a
DO - 10.1097/COC.0b013e31825d580a
M3 - Article
C2 - 22892428
AN - SCOPUS:84892568666
SN - 0277-3732
VL - 36
SP - 612
EP - 619
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 6
ER -