The impact of adjuvant therapy for patients with high-risk diffuse WHO grade II glioma

Ryan S. Youland, Cole R. Kreofsky, David A. Schomas, Paul D. Brown, Jan Craig Buckner, Nadia N Laack

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Despite recent randomized, prospective evidence supporting use of RT and chemotherapy (CRT) for high-risk low-grade gliomas (LGG), many patients have historically received RT alone, chemotherapy alone or observation postoperatively. The purpose of this study is to evaluate outcomes for historical treatments in comparison to CRT for high-risk diffuse WHO grade II glioma patients. Records from 309 adults with WHO grade II glioma (1997–2008) eligible for RTOG 9802 (incomplete resection/biopsy or age ≥40 years) were retrospectively reviewed. Kaplan–Meier estimates were used for progression-free survival (PFS) and overall survival (OS). The Cox proportional hazards model was used for estimates of risk ratios for univariate and multivariate analyses. Median follow-up was 10.6 years. Adjuvant treatments included radiotherapy (RT) alone (45%), observation (31%), CRT (21%) and chemotherapy alone (3%). Non-astrocytic histology, TERT promoter mutation, 1p/19q codeletion and extensive resections were associated with improved PFS and OS on univariate analysis (all p < 0.05). IDH mutations and adjuvant CRT was associated with improved PFS (all p < 0.05). On multivariate analysis, histology, molecular grouping and extent of resection were significantly associated with PFS and OS. In addition, multivariate analysis revealed that CRT was associated with improved PFS and OS compared with RT alone, and improved PFS compared with observation. This study confirms the benefit of adding chemotherapy to RT compared with RT alone or observation. These findings emphasize the need for aggressive treatment in patients with high-risk LGG.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Neuro-Oncology
DOIs
StateAccepted/In press - Aug 23 2017

Fingerprint

Glioma
Disease-Free Survival
Radiotherapy
Observation
Drug Therapy
Survival
Multivariate Analysis
Histology
Therapeutics
Mutation
Proportional Hazards Models
Odds Ratio
Biopsy

Keywords

  • Adjuvant therapy
  • Chemotherapy
  • High-risk low-grade glioma
  • Outcomes
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

The impact of adjuvant therapy for patients with high-risk diffuse WHO grade II glioma. / Youland, Ryan S.; Kreofsky, Cole R.; Schomas, David A.; Brown, Paul D.; Buckner, Jan Craig; Laack, Nadia N.

In: Journal of Neuro-Oncology, 23.08.2017, p. 1-9.

Research output: Contribution to journalArticle

Youland, Ryan S. ; Kreofsky, Cole R. ; Schomas, David A. ; Brown, Paul D. ; Buckner, Jan Craig ; Laack, Nadia N. / The impact of adjuvant therapy for patients with high-risk diffuse WHO grade II glioma. In: Journal of Neuro-Oncology. 2017 ; pp. 1-9.
@article{4e13f9fa65b94cd08d3bac57ed81cc35,
title = "The impact of adjuvant therapy for patients with high-risk diffuse WHO grade II glioma",
abstract = "Despite recent randomized, prospective evidence supporting use of RT and chemotherapy (CRT) for high-risk low-grade gliomas (LGG), many patients have historically received RT alone, chemotherapy alone or observation postoperatively. The purpose of this study is to evaluate outcomes for historical treatments in comparison to CRT for high-risk diffuse WHO grade II glioma patients. Records from 309 adults with WHO grade II glioma (1997–2008) eligible for RTOG 9802 (incomplete resection/biopsy or age ≥40 years) were retrospectively reviewed. Kaplan–Meier estimates were used for progression-free survival (PFS) and overall survival (OS). The Cox proportional hazards model was used for estimates of risk ratios for univariate and multivariate analyses. Median follow-up was 10.6 years. Adjuvant treatments included radiotherapy (RT) alone (45{\%}), observation (31{\%}), CRT (21{\%}) and chemotherapy alone (3{\%}). Non-astrocytic histology, TERT promoter mutation, 1p/19q codeletion and extensive resections were associated with improved PFS and OS on univariate analysis (all p < 0.05). IDH mutations and adjuvant CRT was associated with improved PFS (all p < 0.05). On multivariate analysis, histology, molecular grouping and extent of resection were significantly associated with PFS and OS. In addition, multivariate analysis revealed that CRT was associated with improved PFS and OS compared with RT alone, and improved PFS compared with observation. This study confirms the benefit of adding chemotherapy to RT compared with RT alone or observation. These findings emphasize the need for aggressive treatment in patients with high-risk LGG.",
keywords = "Adjuvant therapy, Chemotherapy, High-risk low-grade glioma, Outcomes, Radiotherapy",
author = "Youland, {Ryan S.} and Kreofsky, {Cole R.} and Schomas, {David A.} and Brown, {Paul D.} and Buckner, {Jan Craig} and Laack, {Nadia N}",
year = "2017",
month = "8",
day = "23",
doi = "10.1007/s11060-017-2599-1",
language = "English (US)",
pages = "1--9",
journal = "Journal of Neuro-Oncology",
issn = "0167-594X",
publisher = "Kluwer Academic Publishers",

}

TY - JOUR

T1 - The impact of adjuvant therapy for patients with high-risk diffuse WHO grade II glioma

AU - Youland, Ryan S.

AU - Kreofsky, Cole R.

AU - Schomas, David A.

AU - Brown, Paul D.

AU - Buckner, Jan Craig

AU - Laack, Nadia N

PY - 2017/8/23

Y1 - 2017/8/23

N2 - Despite recent randomized, prospective evidence supporting use of RT and chemotherapy (CRT) for high-risk low-grade gliomas (LGG), many patients have historically received RT alone, chemotherapy alone or observation postoperatively. The purpose of this study is to evaluate outcomes for historical treatments in comparison to CRT for high-risk diffuse WHO grade II glioma patients. Records from 309 adults with WHO grade II glioma (1997–2008) eligible for RTOG 9802 (incomplete resection/biopsy or age ≥40 years) were retrospectively reviewed. Kaplan–Meier estimates were used for progression-free survival (PFS) and overall survival (OS). The Cox proportional hazards model was used for estimates of risk ratios for univariate and multivariate analyses. Median follow-up was 10.6 years. Adjuvant treatments included radiotherapy (RT) alone (45%), observation (31%), CRT (21%) and chemotherapy alone (3%). Non-astrocytic histology, TERT promoter mutation, 1p/19q codeletion and extensive resections were associated with improved PFS and OS on univariate analysis (all p < 0.05). IDH mutations and adjuvant CRT was associated with improved PFS (all p < 0.05). On multivariate analysis, histology, molecular grouping and extent of resection were significantly associated with PFS and OS. In addition, multivariate analysis revealed that CRT was associated with improved PFS and OS compared with RT alone, and improved PFS compared with observation. This study confirms the benefit of adding chemotherapy to RT compared with RT alone or observation. These findings emphasize the need for aggressive treatment in patients with high-risk LGG.

AB - Despite recent randomized, prospective evidence supporting use of RT and chemotherapy (CRT) for high-risk low-grade gliomas (LGG), many patients have historically received RT alone, chemotherapy alone or observation postoperatively. The purpose of this study is to evaluate outcomes for historical treatments in comparison to CRT for high-risk diffuse WHO grade II glioma patients. Records from 309 adults with WHO grade II glioma (1997–2008) eligible for RTOG 9802 (incomplete resection/biopsy or age ≥40 years) were retrospectively reviewed. Kaplan–Meier estimates were used for progression-free survival (PFS) and overall survival (OS). The Cox proportional hazards model was used for estimates of risk ratios for univariate and multivariate analyses. Median follow-up was 10.6 years. Adjuvant treatments included radiotherapy (RT) alone (45%), observation (31%), CRT (21%) and chemotherapy alone (3%). Non-astrocytic histology, TERT promoter mutation, 1p/19q codeletion and extensive resections were associated with improved PFS and OS on univariate analysis (all p < 0.05). IDH mutations and adjuvant CRT was associated with improved PFS (all p < 0.05). On multivariate analysis, histology, molecular grouping and extent of resection were significantly associated with PFS and OS. In addition, multivariate analysis revealed that CRT was associated with improved PFS and OS compared with RT alone, and improved PFS compared with observation. This study confirms the benefit of adding chemotherapy to RT compared with RT alone or observation. These findings emphasize the need for aggressive treatment in patients with high-risk LGG.

KW - Adjuvant therapy

KW - Chemotherapy

KW - High-risk low-grade glioma

KW - Outcomes

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=85027991491&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027991491&partnerID=8YFLogxK

U2 - 10.1007/s11060-017-2599-1

DO - 10.1007/s11060-017-2599-1

M3 - Article

C2 - 28836106

AN - SCOPUS:85027991491

SP - 1

EP - 9

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

ER -