Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: Results of a prospective clinical trial - Clinical article

Edward G. Shaw, Brian Berkey, Stephen W. Coons, Dennis Bullard, David Brachman, Jan Craig Buckner, Keith J. Stelzer, Geoffrey R. Barger, Paul D. Brown, Mark R. Gilbert, Minesh Mehta

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175 Citations (Scopus)

Abstract

Object. In 1998, the Radiation Therapy Oncology Group initiated a Phase II study of observation for adults < 40 years old with cerebral low-grade glioma who underwent a neurosurgeon-determined gross-total resection (GTR). Methods. Patient eligibility criteria included the presence of a World Health Organization Grade II astrocytoma, oligodendroglioma, or mixed oligoastrocytoma confirmed histologically; age 18-39 years; Karnofsky Performance Scale score ≥ 60; Neurologic Function Scale score ≤ 3; supratentorial tumor location; neurosurgeon-determined GTR; and pre- and postoperative MR imaging with contrast enhancement available for central review by the principal investigator. Patients were observed following GTR and underwent MR imaging every 6 months. Prognostic factors analyzed for their contribution to patient overall survival, progression-free survival (PFS), and tumor recurrence included age, sex, Karnofsky Performance Scale score, Neurologic Function Scale score, histological type, contrast enhancement on preoperative MR imaging, preoperative tumor diameter, residual disease based on postoperative MR imaging, and baseline Mini-Mental State Examination score. Results. Between 1998 and 2002, 111 eligible patients were entered into the study. In these 111 patients, the overall survival rates at 2 and 5 years were 99 and 93%, respectively. The PFS rates in these 111 patients at 2 and 5 years were 82 and 48%, respectively. Three prognostic factors predicted significantly poorer PFS in univariate and multivariate analyses: 1) preoperative tumor diameter ≥ 4 cm; 2) astrocytoma/oligoastrocytoma histological type; and 3) residual tumor ≥ 1 cm according to MR imaging. Review of the postoperative MR imaging results revealed that 59% of patients had < 1 cm residual disease (with a subsequent 26% recurrence rate), 32% had 1-2 cm residual disease (with a subsequent 68% recurrence rate), and 9% had > 2 cm residual disease (with a subsequent 89% recurrence rate). Conclusions. These data suggest that young adult patients with low-grade glioma who undergo a neurosurgeondetermined GTR have a > 50% risk of tumor progression 5-years postoperatively, warranting close follow-up and consideration for adjuvant treatment.

Original languageEnglish (US)
Pages (from-to)835-841
Number of pages7
JournalJournal of Neurosurgery
Volume109
Issue number5
DOIs
StatePublished - Nov 2008

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Radiation Oncology
Glioma
Young Adult
Radiotherapy
Observation
Clinical Trials
Recurrence
Neoplasms
Therapeutics
Neurosurgeons

Keywords

  • Gross-total resection
  • Low-grade glioma
  • Progression-free survival
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma : Results of a prospective clinical trial - Clinical article. / Shaw, Edward G.; Berkey, Brian; Coons, Stephen W.; Bullard, Dennis; Brachman, David; Buckner, Jan Craig; Stelzer, Keith J.; Barger, Geoffrey R.; Brown, Paul D.; Gilbert, Mark R.; Mehta, Minesh.

In: Journal of Neurosurgery, Vol. 109, No. 5, 11.2008, p. 835-841.

Research output: Contribution to journalArticle

Shaw, Edward G. ; Berkey, Brian ; Coons, Stephen W. ; Bullard, Dennis ; Brachman, David ; Buckner, Jan Craig ; Stelzer, Keith J. ; Barger, Geoffrey R. ; Brown, Paul D. ; Gilbert, Mark R. ; Mehta, Minesh. / Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma : Results of a prospective clinical trial - Clinical article. In: Journal of Neurosurgery. 2008 ; Vol. 109, No. 5. pp. 835-841.
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abstract = "Object. In 1998, the Radiation Therapy Oncology Group initiated a Phase II study of observation for adults < 40 years old with cerebral low-grade glioma who underwent a neurosurgeon-determined gross-total resection (GTR). Methods. Patient eligibility criteria included the presence of a World Health Organization Grade II astrocytoma, oligodendroglioma, or mixed oligoastrocytoma confirmed histologically; age 18-39 years; Karnofsky Performance Scale score ≥ 60; Neurologic Function Scale score ≤ 3; supratentorial tumor location; neurosurgeon-determined GTR; and pre- and postoperative MR imaging with contrast enhancement available for central review by the principal investigator. Patients were observed following GTR and underwent MR imaging every 6 months. Prognostic factors analyzed for their contribution to patient overall survival, progression-free survival (PFS), and tumor recurrence included age, sex, Karnofsky Performance Scale score, Neurologic Function Scale score, histological type, contrast enhancement on preoperative MR imaging, preoperative tumor diameter, residual disease based on postoperative MR imaging, and baseline Mini-Mental State Examination score. Results. Between 1998 and 2002, 111 eligible patients were entered into the study. In these 111 patients, the overall survival rates at 2 and 5 years were 99 and 93{\%}, respectively. The PFS rates in these 111 patients at 2 and 5 years were 82 and 48{\%}, respectively. Three prognostic factors predicted significantly poorer PFS in univariate and multivariate analyses: 1) preoperative tumor diameter ≥ 4 cm; 2) astrocytoma/oligoastrocytoma histological type; and 3) residual tumor ≥ 1 cm according to MR imaging. Review of the postoperative MR imaging results revealed that 59{\%} of patients had < 1 cm residual disease (with a subsequent 26{\%} recurrence rate), 32{\%} had 1-2 cm residual disease (with a subsequent 68{\%} recurrence rate), and 9{\%} had > 2 cm residual disease (with a subsequent 89{\%} recurrence rate). Conclusions. These data suggest that young adult patients with low-grade glioma who undergo a neurosurgeondetermined GTR have a > 50{\%} risk of tumor progression 5-years postoperatively, warranting close follow-up and consideration for adjuvant treatment.",
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author = "Shaw, {Edward G.} and Brian Berkey and Coons, {Stephen W.} and Dennis Bullard and David Brachman and Buckner, {Jan Craig} and Stelzer, {Keith J.} and Barger, {Geoffrey R.} and Brown, {Paul D.} and Gilbert, {Mark R.} and Minesh Mehta",
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T2 - Results of a prospective clinical trial - Clinical article

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AU - Berkey, Brian

AU - Coons, Stephen W.

AU - Bullard, Dennis

AU - Brachman, David

AU - Buckner, Jan Craig

AU - Stelzer, Keith J.

AU - Barger, Geoffrey R.

AU - Brown, Paul D.

AU - Gilbert, Mark R.

AU - Mehta, Minesh

PY - 2008/11

Y1 - 2008/11

N2 - Object. In 1998, the Radiation Therapy Oncology Group initiated a Phase II study of observation for adults < 40 years old with cerebral low-grade glioma who underwent a neurosurgeon-determined gross-total resection (GTR). Methods. Patient eligibility criteria included the presence of a World Health Organization Grade II astrocytoma, oligodendroglioma, or mixed oligoastrocytoma confirmed histologically; age 18-39 years; Karnofsky Performance Scale score ≥ 60; Neurologic Function Scale score ≤ 3; supratentorial tumor location; neurosurgeon-determined GTR; and pre- and postoperative MR imaging with contrast enhancement available for central review by the principal investigator. Patients were observed following GTR and underwent MR imaging every 6 months. Prognostic factors analyzed for their contribution to patient overall survival, progression-free survival (PFS), and tumor recurrence included age, sex, Karnofsky Performance Scale score, Neurologic Function Scale score, histological type, contrast enhancement on preoperative MR imaging, preoperative tumor diameter, residual disease based on postoperative MR imaging, and baseline Mini-Mental State Examination score. Results. Between 1998 and 2002, 111 eligible patients were entered into the study. In these 111 patients, the overall survival rates at 2 and 5 years were 99 and 93%, respectively. The PFS rates in these 111 patients at 2 and 5 years were 82 and 48%, respectively. Three prognostic factors predicted significantly poorer PFS in univariate and multivariate analyses: 1) preoperative tumor diameter ≥ 4 cm; 2) astrocytoma/oligoastrocytoma histological type; and 3) residual tumor ≥ 1 cm according to MR imaging. Review of the postoperative MR imaging results revealed that 59% of patients had < 1 cm residual disease (with a subsequent 26% recurrence rate), 32% had 1-2 cm residual disease (with a subsequent 68% recurrence rate), and 9% had > 2 cm residual disease (with a subsequent 89% recurrence rate). Conclusions. These data suggest that young adult patients with low-grade glioma who undergo a neurosurgeondetermined GTR have a > 50% risk of tumor progression 5-years postoperatively, warranting close follow-up and consideration for adjuvant treatment.

AB - Object. In 1998, the Radiation Therapy Oncology Group initiated a Phase II study of observation for adults < 40 years old with cerebral low-grade glioma who underwent a neurosurgeon-determined gross-total resection (GTR). Methods. Patient eligibility criteria included the presence of a World Health Organization Grade II astrocytoma, oligodendroglioma, or mixed oligoastrocytoma confirmed histologically; age 18-39 years; Karnofsky Performance Scale score ≥ 60; Neurologic Function Scale score ≤ 3; supratentorial tumor location; neurosurgeon-determined GTR; and pre- and postoperative MR imaging with contrast enhancement available for central review by the principal investigator. Patients were observed following GTR and underwent MR imaging every 6 months. Prognostic factors analyzed for their contribution to patient overall survival, progression-free survival (PFS), and tumor recurrence included age, sex, Karnofsky Performance Scale score, Neurologic Function Scale score, histological type, contrast enhancement on preoperative MR imaging, preoperative tumor diameter, residual disease based on postoperative MR imaging, and baseline Mini-Mental State Examination score. Results. Between 1998 and 2002, 111 eligible patients were entered into the study. In these 111 patients, the overall survival rates at 2 and 5 years were 99 and 93%, respectively. The PFS rates in these 111 patients at 2 and 5 years were 82 and 48%, respectively. Three prognostic factors predicted significantly poorer PFS in univariate and multivariate analyses: 1) preoperative tumor diameter ≥ 4 cm; 2) astrocytoma/oligoastrocytoma histological type; and 3) residual tumor ≥ 1 cm according to MR imaging. Review of the postoperative MR imaging results revealed that 59% of patients had < 1 cm residual disease (with a subsequent 26% recurrence rate), 32% had 1-2 cm residual disease (with a subsequent 68% recurrence rate), and 9% had > 2 cm residual disease (with a subsequent 89% recurrence rate). Conclusions. These data suggest that young adult patients with low-grade glioma who undergo a neurosurgeondetermined GTR have a > 50% risk of tumor progression 5-years postoperatively, warranting close follow-up and consideration for adjuvant treatment.

KW - Gross-total resection

KW - Low-grade glioma

KW - Progression-free survival

KW - Surgery

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