Management of low-grade glioma: A systematic review and meta-Analysis

Timothy J. Brown, Daniela A. Bota, Martin J. Van Den Bent, Paul D. Brown, Elizabeth Maher, Dawit Aregawi, Linda M. Liau, Jan C. Buckner, Michael Weller, Mitchel S. Berger, Michael Glantz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-Analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods: A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results: Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-Type gliomas. Conclusions: Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

Original languageEnglish (US)
Article numbernpy034
Pages (from-to)249-258
Number of pages10
JournalNeuro-Oncology Practice
Volume6
Issue number4
DOIs
StatePublished - Jul 27 2019

Fingerprint

Glioma
Meta-Analysis
Drug Therapy
Disease-Free Survival
Radiation
Mortality
Isocitrate Dehydrogenase
Genes
Clinical Trials
Guidelines
Biopsy
Mutation

Keywords

  • chemotherapy
  • extent of resection
  • low-grade glioma therapy
  • overall survival
  • radiation

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Brown, T. J., Bota, D. A., Van Den Bent, M. J., Brown, P. D., Maher, E., Aregawi, D., ... Glantz, M. (2019). Management of low-grade glioma: A systematic review and meta-Analysis. Neuro-Oncology Practice, 6(4), 249-258. [npy034]. https://doi.org/10.1093/nop/npy034

Management of low-grade glioma : A systematic review and meta-Analysis. / Brown, Timothy J.; Bota, Daniela A.; Van Den Bent, Martin J.; Brown, Paul D.; Maher, Elizabeth; Aregawi, Dawit; Liau, Linda M.; Buckner, Jan C.; Weller, Michael; Berger, Mitchel S.; Glantz, Michael.

In: Neuro-Oncology Practice, Vol. 6, No. 4, npy034, 27.07.2019, p. 249-258.

Research output: Contribution to journalArticle

Brown, TJ, Bota, DA, Van Den Bent, MJ, Brown, PD, Maher, E, Aregawi, D, Liau, LM, Buckner, JC, Weller, M, Berger, MS & Glantz, M 2019, 'Management of low-grade glioma: A systematic review and meta-Analysis', Neuro-Oncology Practice, vol. 6, no. 4, npy034, pp. 249-258. https://doi.org/10.1093/nop/npy034
Brown TJ, Bota DA, Van Den Bent MJ, Brown PD, Maher E, Aregawi D et al. Management of low-grade glioma: A systematic review and meta-Analysis. Neuro-Oncology Practice. 2019 Jul 27;6(4):249-258. npy034. https://doi.org/10.1093/nop/npy034
Brown, Timothy J. ; Bota, Daniela A. ; Van Den Bent, Martin J. ; Brown, Paul D. ; Maher, Elizabeth ; Aregawi, Dawit ; Liau, Linda M. ; Buckner, Jan C. ; Weller, Michael ; Berger, Mitchel S. ; Glantz, Michael. / Management of low-grade glioma : A systematic review and meta-Analysis. In: Neuro-Oncology Practice. 2019 ; Vol. 6, No. 4. pp. 249-258.
@article{9572029962a74993847d53dd5dfc0be6,
title = "Management of low-grade glioma: A systematic review and meta-Analysis",
abstract = "Background: Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-Analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods: A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results: Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-Type gliomas. Conclusions: Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.",
keywords = "chemotherapy, extent of resection, low-grade glioma therapy, overall survival, radiation",
author = "Brown, {Timothy J.} and Bota, {Daniela A.} and {Van Den Bent}, {Martin J.} and Brown, {Paul D.} and Elizabeth Maher and Dawit Aregawi and Liau, {Linda M.} and Buckner, {Jan C.} and Michael Weller and Berger, {Mitchel S.} and Michael Glantz",
year = "2019",
month = "7",
day = "27",
doi = "10.1093/nop/npy034",
language = "English (US)",
volume = "6",
pages = "249--258",
journal = "Neuro-Oncology Practice",
issn = "2054-2577",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Management of low-grade glioma

T2 - A systematic review and meta-Analysis

AU - Brown, Timothy J.

AU - Bota, Daniela A.

AU - Van Den Bent, Martin J.

AU - Brown, Paul D.

AU - Maher, Elizabeth

AU - Aregawi, Dawit

AU - Liau, Linda M.

AU - Buckner, Jan C.

AU - Weller, Michael

AU - Berger, Mitchel S.

AU - Glantz, Michael

PY - 2019/7/27

Y1 - 2019/7/27

N2 - Background: Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-Analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods: A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results: Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-Type gliomas. Conclusions: Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

AB - Background: Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-Analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods: A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results: Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-Type gliomas. Conclusions: Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

KW - chemotherapy

KW - extent of resection

KW - low-grade glioma therapy

KW - overall survival

KW - radiation

UR - http://www.scopus.com/inward/record.url?scp=85073908626&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85073908626&partnerID=8YFLogxK

U2 - 10.1093/nop/npy034

DO - 10.1093/nop/npy034

M3 - Article

AN - SCOPUS:85073908626

VL - 6

SP - 249

EP - 258

JO - Neuro-Oncology Practice

JF - Neuro-Oncology Practice

SN - 2054-2577

IS - 4

M1 - npy034

ER -