Changes in presentation, treatment, and outcomes of adult low-grade gliomas over the past fifty years

Ryan S. Youland, David A. Schomas, Paul D. Brown, Chika Nwachukwu, Jan Craig Buckner, Caterina Giannini, Ian F Parney, Nadia N Laack

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

BackgroundTo identify changes in patient presentation, treatment, and outcomes of low-grade gliomas (LGGs) over the past 50 years.MethodsRecords of 852 adults who received a diagnosis at Mayo Clinic from 1960 through 2011 with World Health Organization grade II LGGs were reviewed and grouped by those who received a diagnosis before (group I: 1960-1989) and after (group II: 1990-2011) the routine use of postoperative MRI.ResultsMedian follow-up was 23.3 and 8.7 years for groups I and II, respectively. Patients in group I more often presented with seizures, headaches, sensory/motor impairment, and astrocytoma histology. Over time, more gross total resections (GTRs) were achieved, fewer patients received postoperative radiotherapy (PORT), and more received chemotherapy.Median progression-free survival (PFS) and overall survival (OS) were 4.4 and 8.0 years, respectively. Although PFS was similar, 10-year OS was better in group II (47%) than in group I (33%; P <. 0001). Improved PFS in multivariate analysis was associated with group I patients, nonastrocytoma histology, small tumor size, successful GTR, or radical subtotal resection (rSTR), PORT, and postoperative chemotherapy. Factors associated with improved OS in multivariate analysis were younger age, nonastrocytoma histology, small tumor size, and GTR/rSTR.ConclusionsOS for LGG has improved over the past 50 years, despite similar rates of progression. In the modern cohort, more patients are receiving a diagnosis of oligodendroglioma and are undergoing extensive resections, both of which are associated with improvements in OS. Because of risk factor stratification by clinicians, the use of PORT has decreased and is primarily being used to treat high-risk tumors in modern patients.

Original languageEnglish (US)
Pages (from-to)1102-1110
Number of pages9
JournalNeuro-Oncology
Volume15
Issue number8
DOIs
StatePublished - Aug 2013

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Glioma
Disease-Free Survival
Histology
Radiotherapy
Survival
Multivariate Analysis
Oligodendroglioma
Drug Therapy
Neoplasms
Astrocytoma
Headache
Seizures

Keywords

  • central nervous system tumors
  • external-beam radiotherapy
  • low-grade glioma
  • neurosurgery
  • oligodendroglioma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology

Cite this

Changes in presentation, treatment, and outcomes of adult low-grade gliomas over the past fifty years. / Youland, Ryan S.; Schomas, David A.; Brown, Paul D.; Nwachukwu, Chika; Buckner, Jan Craig; Giannini, Caterina; Parney, Ian F; Laack, Nadia N.

In: Neuro-Oncology, Vol. 15, No. 8, 08.2013, p. 1102-1110.

Research output: Contribution to journalArticle

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abstract = "BackgroundTo identify changes in patient presentation, treatment, and outcomes of low-grade gliomas (LGGs) over the past 50 years.MethodsRecords of 852 adults who received a diagnosis at Mayo Clinic from 1960 through 2011 with World Health Organization grade II LGGs were reviewed and grouped by those who received a diagnosis before (group I: 1960-1989) and after (group II: 1990-2011) the routine use of postoperative MRI.ResultsMedian follow-up was 23.3 and 8.7 years for groups I and II, respectively. Patients in group I more often presented with seizures, headaches, sensory/motor impairment, and astrocytoma histology. Over time, more gross total resections (GTRs) were achieved, fewer patients received postoperative radiotherapy (PORT), and more received chemotherapy.Median progression-free survival (PFS) and overall survival (OS) were 4.4 and 8.0 years, respectively. Although PFS was similar, 10-year OS was better in group II (47{\%}) than in group I (33{\%}; P <. 0001). Improved PFS in multivariate analysis was associated with group I patients, nonastrocytoma histology, small tumor size, successful GTR, or radical subtotal resection (rSTR), PORT, and postoperative chemotherapy. Factors associated with improved OS in multivariate analysis were younger age, nonastrocytoma histology, small tumor size, and GTR/rSTR.ConclusionsOS for LGG has improved over the past 50 years, despite similar rates of progression. In the modern cohort, more patients are receiving a diagnosis of oligodendroglioma and are undergoing extensive resections, both of which are associated with improvements in OS. Because of risk factor stratification by clinicians, the use of PORT has decreased and is primarily being used to treat high-risk tumors in modern patients.",
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AU - Youland, Ryan S.

AU - Schomas, David A.

AU - Brown, Paul D.

AU - Nwachukwu, Chika

AU - Buckner, Jan Craig

AU - Giannini, Caterina

AU - Parney, Ian F

AU - Laack, Nadia N

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N2 - BackgroundTo identify changes in patient presentation, treatment, and outcomes of low-grade gliomas (LGGs) over the past 50 years.MethodsRecords of 852 adults who received a diagnosis at Mayo Clinic from 1960 through 2011 with World Health Organization grade II LGGs were reviewed and grouped by those who received a diagnosis before (group I: 1960-1989) and after (group II: 1990-2011) the routine use of postoperative MRI.ResultsMedian follow-up was 23.3 and 8.7 years for groups I and II, respectively. Patients in group I more often presented with seizures, headaches, sensory/motor impairment, and astrocytoma histology. Over time, more gross total resections (GTRs) were achieved, fewer patients received postoperative radiotherapy (PORT), and more received chemotherapy.Median progression-free survival (PFS) and overall survival (OS) were 4.4 and 8.0 years, respectively. Although PFS was similar, 10-year OS was better in group II (47%) than in group I (33%; P <. 0001). Improved PFS in multivariate analysis was associated with group I patients, nonastrocytoma histology, small tumor size, successful GTR, or radical subtotal resection (rSTR), PORT, and postoperative chemotherapy. Factors associated with improved OS in multivariate analysis were younger age, nonastrocytoma histology, small tumor size, and GTR/rSTR.ConclusionsOS for LGG has improved over the past 50 years, despite similar rates of progression. In the modern cohort, more patients are receiving a diagnosis of oligodendroglioma and are undergoing extensive resections, both of which are associated with improvements in OS. Because of risk factor stratification by clinicians, the use of PORT has decreased and is primarily being used to treat high-risk tumors in modern patients.

AB - BackgroundTo identify changes in patient presentation, treatment, and outcomes of low-grade gliomas (LGGs) over the past 50 years.MethodsRecords of 852 adults who received a diagnosis at Mayo Clinic from 1960 through 2011 with World Health Organization grade II LGGs were reviewed and grouped by those who received a diagnosis before (group I: 1960-1989) and after (group II: 1990-2011) the routine use of postoperative MRI.ResultsMedian follow-up was 23.3 and 8.7 years for groups I and II, respectively. Patients in group I more often presented with seizures, headaches, sensory/motor impairment, and astrocytoma histology. Over time, more gross total resections (GTRs) were achieved, fewer patients received postoperative radiotherapy (PORT), and more received chemotherapy.Median progression-free survival (PFS) and overall survival (OS) were 4.4 and 8.0 years, respectively. Although PFS was similar, 10-year OS was better in group II (47%) than in group I (33%; P <. 0001). Improved PFS in multivariate analysis was associated with group I patients, nonastrocytoma histology, small tumor size, successful GTR, or radical subtotal resection (rSTR), PORT, and postoperative chemotherapy. Factors associated with improved OS in multivariate analysis were younger age, nonastrocytoma histology, small tumor size, and GTR/rSTR.ConclusionsOS for LGG has improved over the past 50 years, despite similar rates of progression. In the modern cohort, more patients are receiving a diagnosis of oligodendroglioma and are undergoing extensive resections, both of which are associated with improvements in OS. Because of risk factor stratification by clinicians, the use of PORT has decreased and is primarily being used to treat high-risk tumors in modern patients.

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