Evidence-based clinical practice parameter guidelines for the treatment of adults with diffuse low grade glioma: introduction and methods

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.

Download Full-text

Evidence-based clinical practice parameter guidelines for the treatment of patients with metastatic brain tumors: introduction

Journal of Neuro-Oncology ◽

10.1007/s11060-009-0065-4 ◽

2009 ◽

Vol 96 (1) ◽

pp. 7-10 ◽

Cited By ~ 28

Author(s):

Steven N. Kalkanis ◽

Mark E. Linskey

Keyword(s):

Clinical Practice ◽

Brain Tumors ◽

Evidence Based ◽

Practice Parameter ◽

Metastatic Brain Tumors

Download Full-text

One year of procarbazine lomustine and vincristine is poorly tolerated in low grade glioma: a real world experience in a national neuro-oncology centre

BMC Cancer ◽

10.1186/s12885-021-07809-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rachel J. Keogh ◽

Razia Aslam ◽

Maeve A. Hennessy ◽

Zac Coyne ◽

Bryan T. Hennessy ◽

...

Keyword(s):

Clinical Practice ◽

Local Therapy ◽

Dose Intensity ◽

Low Grade Glioma ◽

Randomised Control Trial ◽

Low Grade ◽

Oncology Centre ◽

Dose Modifications ◽

Experienced Grade ◽

Grade Iii

Abstract Background Following optimal local therapy, adjuvant Procarbazine, Lomustine and Vincristine (PCV) improves overall survival (OS) in low-grade glioma (LGG). However, 1 year of PCV is associated with significant toxicities. In the pivotal RTOG 9802 randomised control trial, approximately half of the patients discontinued treatment after 6 months. As patients on clinical trials may be fitter, we aimed to further explore the tolerability of PCV chemotherapy in routine clinical practice. Methods We conducted a retrospective study between 2014 and 2018 at a National Neuro-Oncology centre. Patients who had received PCV during this time period were included. The primary objective was to assess tolerability of treatment. Secondary objectives included evaluation of treatment delays, dose modifications and toxicities. Results Overall, 41 patients were included, 24 (58%) were male and 21 (51%) aged ≥40 years. 38 (93%) underwent surgical resection and all patients received adjuvant radiotherapy prior to chemotherapy. The median number of cycles completed was 3,2,4 for procarbazine, lomustine and vincristine respectively. Only 4 (10%) completed all 6 cycles of PCV without dose modifications. There was a universal decline in dose intensity as cycles of chemotherapy progressed. Dose intensity for cycle 1 versus cycle 6 respectively: procarbazine (98% versus 46%), lomustine (94% versus 48%) and vincristine (93% versus 50%). Haematological toxicities were common. Six (14%) patients experienced Grade III-IV thrombocytopaenia and 13 (31%) experienced Grade III-IV neutropaenia. Conclusion Toxicities are frequently observed with the PCV regimen in clinical practice. It might be preferable to adjust doses from the start of chemotherapy to improve tolerability or consider alternative chemotherapy, particularly in older patients with LGG.

Download Full-text

Methodology used to develop the AANS/CNS management of brain metastases evidence-based clinical practice parameter guidelines

Journal of Neuro-Oncology ◽

10.1007/s11060-009-0059-2 ◽

2009 ◽

Vol 96 (1) ◽

pp. 11-16 ◽

Cited By ~ 26

Author(s):

Paula D. Robinson ◽

Steven N. Kalkanis ◽

Mark E. Linskey ◽

P. Lina Santaguida

Keyword(s):

Clinical Practice ◽

Brain Metastases ◽

Evidence Based ◽

Practice Parameter

Download Full-text

EASE: Clinical Implementation of Automated Tumor Segmentation and Volume Quantification for Adult Low-Grade Glioma

Frontiers in Medicine ◽

10.3389/fmed.2021.738425 ◽

2021 ◽

Vol 8 ◽

Author(s):

Karin A. van Garderen ◽

Sebastian R. van der Voort ◽

Adriaan Versteeg ◽

Marcel Koek ◽

Andrea Gutierrez ◽

...

Keyword(s):

Clinical Practice ◽

Automatic Segmentation ◽

Low Grade Glioma ◽

Tumor Segmentation ◽

Low Grade ◽

Clinical Implementation ◽

Volumetric Assessment ◽

Ensure Patient Safety ◽

Volume Measurements ◽

The Individual

The growth rate of non-enhancing low-grade glioma has prognostic value for both malignant progression and survival, but quantification of growth is difficult due to the irregular shape of the tumor. Volumetric assessment could provide a reliable quantification of tumor growth, but is only feasible if fully automated. Recent advances in automated tumor segmentation have made such a volume quantification possible, and this work describes the clinical implementation of automated volume quantification in an application named EASE: Erasmus Automated SEgmentation. The visual quality control of segmentations by the radiologist is an important step in this process, as errors in the segmentation are still possible. Additionally, to ensure patient safety and quality of care, protocols were established for the usage of volume measurements in clinical diagnosis and for future updates to the algorithm. Upon the introduction of EASE into clinical practice, we evaluated the individual segmentation success rate and impact on diagnosis. In its first 3 months of usage, it was applied to a total of 55 patients, and in 36 of those the radiologist was able to make a volume-based diagnosis using three successful consecutive measurements from EASE. In all cases the volume-based diagnosis was in line with the conventional visual diagnosis. This first cautious introduction of EASE in our clinic is a valuable step in the translation of automatic segmentation methods to clinical practice.

Download Full-text

One Year of Procarbazine Lomustine and Vincristine is Poorly Tolerated in Low Grade Glioma: A Real World Experience in a National Neuro-Oncology Centre

10.21203/rs.3.rs-115879/v1 ◽

2020 ◽

Author(s):

Rachel Keogh ◽

Razia Aslam ◽

Maeve Hennessy ◽

Zac Coyne ◽

Bryan Hennessy ◽

...

Keyword(s):

Clinical Practice ◽

Dose Intensity ◽

Low Grade Glioma ◽

Randomised Control Trial ◽

Low Grade ◽

One Year ◽

Oncology Centre ◽

Dose Modifications ◽

Experienced Grade ◽

Grade Iii

Abstract BackgroundFollowing optimal local therapy, adjuvant Procarbazine, Lomustine and Vincristine (PCV) improves overall survival (OS) in low-grade glioma (LGG). However, one year of PCV is associated with significant toxicities. In the pivotal RTOG 9802 randomised control trial, approximately half of the patients discontinued treatment after six months. As patients on clinical trials may be fitter, we aimed to further explore the tolerability of PCV chemotherapy in routine clinical practice. MethodsWe conducted a retrospective study between 2014 and 2018 at a National Neuro-Oncology centre. Patients who had received PCV during this time period were included. The primary objective was to assess tolerability of treatment. Secondary objectives included evaluation of treatment delays, dose modifications and toxicities. ResultsOverall, 41 patients were included, 24 (58%) were male and 21 (51%) aged ≥ 40 years. Overall, 38 (93%) underwent surgical resection and all patients received adjuvant radiotherapy prior to chemotherapy. The median number of cycles completed was 3,2,4 for procarbazine, lomustine and vincristine respectively. Only 4 (10%) completed all six cycles of PCV without dose modifications. There was a universal decline in dose intensity as cycles of chemotherapy progressed. Dose intensity for cycle 1 versus cycle 6 respectively: procarbazine (98% versus 46%), lomustine (94% versus 48%) and vincristine (93% versus 50%). Haematological toxicities were common. Six (14%) patients experienced Grade III-IV thrombocytopaenia and 13 (31%) experienced Grade III-IV neutropaenia. ConclusionToxicities are frequently observed with the PCV regimen in clinical practice. It might be preferable to adjust doses from the start of chemotherapy to improve tolerability or consider alternative chemotherapy, particularly in older patients with LGG.

Download Full-text