Final report from Intergroup NCCTG 86-72-51 (Alliance): A phase III randomized clinical trial of high-dose versus low-dose radiation for adult low-grade glioma

William G. Breen, S. Keith Anderson, Xiomara W. Carrero, Paul D. Brown, Karla V. Ballman, Brian P. O'Neill, Walter J. Curran, Ross A. Abrams, Nadia N. Laack, Ralph Levitt, Evanthia Galanis, Jan C. Buckner, Edward G. Shaw

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

The optimal radiation dose for adult supratentorial low-grade glioma is unknown. The aim of this study was to provide a final update on oncologic and cognitive outcomes of high-dose versus low-dose radiation for low-grade glioma. Methods: Between 1986 and 1994, 203 patients with supratentorial low-grade glioma were randomized (1:1) to 50.4 Gy in 28 fractions versus 64.8 Gy in 36 fractions after any degree of resection. Results: For all patients, median overall survival (OS) was 8.4 years (95% CI: 7.2-10.8). Median progression-free survival (PFS) was 5.2 years (95% CI: 4.3-6.6). Median follow-up is 17.2 years for the 33 patients still alive. High-dose radiation did not improve 15-year OS (22.4%) versus low-dose radiation (24.9%, log-rank P=0.978) or 15-year PFS (high dose, 15.2% vs low dose, 9.5%; P=0.7142). OS was significantly better for patients with preoperative tumor diameter <5 cm and baseline Mini-Mental State Examination (MMSE) >27 and who underwent gross total resection. PFS was improved for patients with oligodendroglioma versus astrocytoma, preoperative tumor diameter <5 cm, patients who had gross total resection, and patients with baseline MMSE >27. For patients who had normal MMSE at baseline, at 7 years only 1 patient (5%) had a clinically significant decrease in MMSE from the previous time point, with the remainder (95%) stable. None had decrease in MMSE at 10, 12, or 15 years. Conclusions: Long-term follow-up indicates no benefit to high-dose over low-dose radiation for low-grade gliomas. Cognitive function appeared to be stable after radiation as measured by MMSE.

Original languageEnglish (US)
Pages (from-to)830-837
Number of pages8
JournalNeuro-oncology
Volume22
Issue number6
DOIs
StatePublished - Jun 9 2020

Keywords

  • clinical trials
  • cognition following radiation
  • glioma
  • neurosurgery
  • radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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