scholarly journals RADT-31. PATTERNS OF CARE IN THE USE OF ADJUVANT RADIOTHERAPY AND CHEMOTHERAPY IN LOW GRADE GLIOMA PATIENTS IN THE UNITED STATES FROM 2010-2016

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii188-ii188
Author(s):  
Warren Rehrer ◽  
Yazmin Odia ◽  
Muni Rubens ◽  
Noah Kalman ◽  
Michael Chuong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Adjuvant Radiotherapy ◽  
Single Agent ◽  
The United States ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Who Grade ◽  
Trimodality Therapy ◽  
Number Of Patients

Abstract PURPOSE In 2016, RTOG 9802 reported an overall survival advantage with the addition of chemotherapy to adjuvant radiotherapy (CRT) in patients with high-risk low grade glioma (LGG). We used the National Cancer Database (NCDB) to measure trends in CRT use in LGG patients from 2010-2016, a period when no Level 1 evidence existed. METHODS The NCDB was queried for WHO Grade II glioma patients treated from 2010-2016 who met the inclusion criteria for RTOG 9802. Adjusted logistic regression was used to assess the association of treatment year with the annual percentage of patients who received adjuvant CRT. Relative percent change and average annual percentage change (AAPC) were compared to determine if a change (defined a priori as < 0.01) occurred in the use of adjuvant CRT in LGG patients during this period. RESULTS The analytic cohort consisted of 5,039 patients; 64.3% of patients were 40 years or older and 35.7% were under 40 with subtotal resection. Use of adjuvant CRT increased from 18.9% to 49.7% (p< 0.001) during 2013-2016, with no change observed before 2013. The AAPC in the use of CRT was +39.6% per year (p< 0.001). Corresponding declines in patients treated with surgery alone (p< 0.001) and surgery plus radiotherapy (p< 0.001) were observed during 2013-2016. Logistic regression demonstrated patients who were under 40 years old were significantly less likely to receive adjuvant CRT than patients 40 years or older (Odds Ratio 0.561, 95% CI 0.475-0.663, p< 0.001). Use of adjuvant CRT increased from 12.5% to 45.1% in patients with oligodendroglioma during 2013-2016 (p< 0.001). CONCLUSIONS During 2013-2016, an increasing number of patients with LGG were treated with surgery followed by adjuvant CRT. Future studies may characterize the use of single agent vs. multiagent chemotherapy in this population and the adoption of trimodality therapy by mutation status.

WP1-17 Risk factors and patterns of progression in a surgical cohort of low grade glioma patients

2019 ◽  
Vol 90 (3) ◽  
pp. e6.2-e6
Author(s):  
S Acharya ◽  
J Lavrador ◽  
R Visagan ◽  
V Narbad ◽  
J Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Neurosurgical Procedures ◽  
Volumetric Change ◽  
Who Grade ◽  
Adjusted Analysis

ObjectivesTo understand the risk factors for and patterns of progression of low grade glioma (LGG).DesignSingle centre retrospective cohort study.SubjectsPatients undergoing at least two neurosurgical procedures for LGG, the first being for diffuse LGG (WHO 2). 22 patients included (14M; 8F); mean age at time of first operation 37.7±2.7 years. 20 patients had a Performance Status (PS) 0–1 and 2 patients had a PS 2.MethodsAll patients with LGG diagnosed in between 2009–2018 were retrospectively evaluated. Variables of interest included demographics, staging, performance status, time to re-operation (TTR), extent of resection, molecular genetics (1p19q co-deletion, IDH status). Tumour volumes were estimated from MRI images by the validated ABC/2 equation. Statistical analyses were performed by Stata13.0.ResultsThe tumour progressed in WHO grade in 18 patients (WHO grade 3 (n=15); WHO grade 4 (n=3). Mean time to re-operation after the first surgery was 7.0±1.2 years following gross total resection (GTR) and 3.2±0.7 years following subtotal resection (STR). Non-adjusted analysis of risk factors for time to re-operation (TTR) showed absence of 1p19q co-deletion as a risk factor (p=0.021). Adjusted analysis revealed that GTR, 1p19q mutation, PS 0 at 1 st surgery and tumour volumetric change decrease the risk for re-intervention (p<0.05). Chemo-radiotherapy was not associated with TTR.ConclusionsIn our cohort, TTR in LGG was influenced by the amount of initial resection, 1p19q deletion, PS and post-operative volumetric change.

scholarly journals Intracranial Low Grade Glioma: a Clinical Study of 35 Cases in a Teaching Institute

2019 ◽  
Vol 23 (4) ◽  
Author(s):  
GOHAR ALI ◽  
SOHAIL AMIR ◽  
KHALID MEHMOOD ◽  
AEEM-UL- HAQ
Keyword(s):  
Surgical Outcome ◽  
Seizure Control ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Karnofsky Performance Score ◽  
Karnofsky Score ◽  
Total Resection ◽  
Number Of Patients

Objective: To determine the clinical manifestation and surgical outcome of patients with low grade Glioma.Material and Methods: This descriptive (cross sectional) study was done at the Neurosurgery Department, Mardan Medical Complex Mardan. The study period was March 2017 to February 2018. Patient of any age and gender presented to outpatient department or referred from some other medical facility and diagnosed as low grade Glioma on clinical and radiological grounds and later confirmed by histopathology were included. Results: Out of 35 patients, 20 (57%) were male and 15 (42%) were female. 20 to 80 years was the age range and mean age was 46.36 ± 17.11 years. Frontal lobe was the most frequent area of location, followed by parietal 9 (25%) and temporal 8 (22%) lobe. Pre-operativeKarnofsky score was 90 in 16 (45%), 80 in 8 (22%), 70 in 6 (17%) and 60 in 5 (14%) of patients. Gross total resection was achieved in 13 (37%), radical subtotal resection in 10 (28%), subtotal resection in 10 (28%) and biopsy taken in 02 (5%) patients. histopathology revealed Astrocytoma in 15 (42%), mixed Oligoastrocytoma in 12 (34%) and Oligodendroglioma in 8 (22%) number of patients. Post operatively surgical outcome was measured by improvement in symptomatology, Karnofsky score and seizure control. Conclusion: Conscious level, Karnofsky Performance score, seizure control are important parameters for surgical outcome in patients with low grade Gliomas. Gross total resection of the tumor is a better option for good surgical outcome.

scholarly journals Effect of the Addition of Chemotherapy to Radiotherapy on Cognitive Function in Patients With Low-Grade Glioma: Secondary Analysis of RTOG 98-02

2014 ◽  
Vol 32 (6) ◽  
pp. 535-541 ◽  
Author(s):  
Roshan S. Prabhu ◽  
Minhee Won ◽  
Edward G. Shaw ◽  
Chen Hu ◽  
David G. Brachman ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Mmse Score ◽  
Randomized Study ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Who Grade ◽  
Term Survival ◽  
Over Time

Purpose The addition of PCV (procarbazine, lomustine, and vincristine) chemotherapy to radiotherapy (RT) for patients with WHO grade 2 glioma improves progression-free survival (PFS). The effect of therapy intensification on cognitive function (CF) remains a concern in this population with substantial long-term survival. Patients and Methods A total of 251 patients with WHO grade 2 glioma age ≥ 40 years with any extent of resection or age < 40 years with subtotal resection/biopsy were randomly assigned to RT (54 Gy) or RT plus PCV. We observed 111 patients age < 40 years with gross total resection. CF was assessed by Mini–Mental State Examination (MMSE) at baseline and years 1, 2, 3, and 5. Results Overall, few patients experienced significant decline in MMSE score. There were no significant differences in the proportion of patients experiencing MMSE score decline between the randomized study arms at any time point. Both study arms experienced a significant gain in average MMSE score longitudinally over time, with no difference between arms. Conclusion The MMSE is a relatively insensitive tool, and subtle changes in CF may have been missed. However, the addition of PCV to RT did not result in significantly higher rates of MMSE score decline than RT alone through 5 years of follow-up. Patients in both randomly assigned arms experienced a statistically significant average MMSE score increase over time, with no difference between arms. The addition of PCV chemotherapy to RT improves PFS without excessive CF detriment over RT alone for patients with low-grade glioma.

scholarly journals Randomized Trial of Radiation Therapy Plus Procarbazine, Lomustine, and Vincristine Chemotherapy for Supratentorial Adult Low-Grade Glioma: Initial Results of RTOG 9802

2012 ◽  
Vol 30 (25) ◽  
pp. 3065-3070 ◽  
Author(s):  
Edward G. Shaw ◽  
Meihua Wang ◽  
Stephen W. Coons ◽  
David G. Brachman ◽  
Jan C. Buckner ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Radiation Therapy Oncology Group ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Eligibility Criteria ◽  
Who Grade ◽  
Free Survival ◽  
Post Hoc

PurposeA prior Radiation Therapy Oncology Group (RTOG) clinical trial in anaplastic oligodendroglioma suggested a progression-free survival benefit for procarbazine, lomustine, and vincristine (PCV) chemotherapy in addition to radiation therapy (RT), as have smaller trials in low-grade glioma (LGG).Patients and MethodsEligibility criteria included supratentorial WHO grade 2 LGG, age 18 to 39 years with subtotal resection/biopsy, or age ≥ 40 years with any extent resection. Patients were randomly assigned to RT alone or RT followed by six cycles of PCV. Survival was compared by using the modified Wilcoxon and log-rank tests.ResultsIn all, 251 patients were accrued from 1998 to 2002. Median overall survival (OS) time and 5-year OS rates for RT versus RT + PCV were 7.5 years versus not reached and 63% versus 72%, respectively (hazard ratio [HR]; 0.72; 95% CI, 0.47 to 1.10; P = .33; log-rank P = .13). Median progression-free survival (PFS) time and 5-year PFS rates for RT versus RT + PCV were 4.4 years versus not reached and 46% versus 63%, respectively (HR, 0.6; 95% CI, 0.41 to 0.86; P = .06; log-rank P = .005). OS and PFS were similar for all patients between years 0 and 2. After 2 years, OS and PFS curves separated significantly, favoring RT + PCV. For 2-year survivors (n = 211), the probability of OS for an additional 5 years was 74% with RT + PCV versus 59% with RT alone (HR, 0.52; 95% CI, 0.30 to 0.90; log-rank P = .02).ConclusionPFS but not OS was improved for adult patients with LGG receiving RT + PCV versus RT alone. On post hoc analysis, for 2-year survivors, the addition of PCV to RT conferred a survival advantage, suggesting a delayed benefit for chemotherapy.

scholarly journals Survival and low-grade glioma: the emergence of genetic information

2015 ◽  
Vol 38 (1) ◽  
pp. E6 ◽  
Author(s):  
Elizabeth B. Claus ◽  
Kyle M. Walsh ◽  
John K. Wiencke ◽  
Annette M. Molinaro ◽  
Joseph L. Wiemels ◽  
...  
Keyword(s):  
Expression Profiles ◽  
Young Patients ◽  
High Grade Glioma ◽  
The United States ◽  
Low Grade Glioma ◽  
World Health ◽  
Low Grade ◽  
High Grade ◽  
Who Grade ◽  
Health Organization

Significant gaps exist in our understanding of the causes and clinical management of glioma. One of the biggest gaps is how best to manage low-grade (World Health Organization [WHO] Grade II) glioma. Low-grade glioma (LGG) is a uniformly fatal disease of young adults (mean age 41 years), with survival averaging approximately 7 years. Although LGG patients have better survival than patients with high-grade (WHO Grade III or IV) glioma, all LGGs eventually progress to high-grade glioma and death. Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute suggest that for the majority of LGG patients, overall survival has not significantly improved over the past 3 decades, highlighting the need for intensified study of this tumor. Recently published research suggests that historically used clinical variables are not sufficient (and are likely inferior) prognostic and predictive indicators relative to information provided by recently discovered tumor markers (e.g., 1p/19q deletion and IDH1 or IDH2 mutation status), tumor expression profiles (e.g., the proneural profile) and/or constitutive genotype (e.g., rs55705857 on 8q24.21). Discovery of such tumor and constitutive variation may identify variables needed to improve randomization in clinical trials as well as identify patients more sensitive to current treatments and targets for improved treatment in the future. This article reports on survival trends for patients diagnosed with LGG within the United States from 1973 through 2011 and reviews the emerging role of tumor and constitutive genetics in refining risk stratification, defining targeted therapy, and improving survival for this group of relatively young patients.

The effect of the addition of chemotherapy to radiotherapy on cognitive function in patients with low-grade glioma: Secondary analysis of RTOG 98-02.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2047-2047
Author(s):  
Roshan Sudhir Prabhu ◽  
Minhee Won ◽  
Edward G. Shaw ◽  
Meihua Wang ◽  
David Brachman ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Mmse Score ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Who Grade ◽  
Term Survival ◽  
Who Grade Ii Glioma ◽  
Grade Ii ◽  
Grade Ii Glioma

2047 Background: The addition of PCV chemotherapy to radiotherapy (RT) for patients with WHO grade II glioma improves progression free survival (PFS) and overall survival (OS), for patients surviving at least 2 years (Shaw, J Clin Oncol 26: 2008). The effect of therapy intensification on cognitive function (CF) remains a concern in this population with substantial long term survival. Methods: 251patients with WHO grade II glioma and age > 40 with any extent of resection, or age < 40 with subtotal resection/biopsy were randomized to RT (54Gy) or RT + PCV. 111 patients with age < 40 and gross total resection were observed. CF was assessed by mini-mental status exam (MMSE)at baseline and years 1, 3, and 5 for patients without progression. Change in MMSE score from baseline of > 3 points was considered clinically significant. Results: Overall, very few patients experienced significant decline in MMSE score, with a median follow-up time of 9.7 years for alive patients. There were no significant differences in the proportion of patients experiencing MMSE decline between study arms at any time point. The table below summarizes MMSE change from baseline over time. Neither baseline MMSE score nor change in MMSE at year 1 significantly predicted for OS or PFS, but there was a trend towards worse OS for patients with MMSE loss of ≥ 2 points [HR 1.73, 95% CI (0.86, 3.47), p=0.12]. Conclusions: The MMSE is a relatively insensitive tool that has not been validated in patients receiving cranial RT, and subtle changes in CF may have been missed. However, the addition of PCV to RT for low grade glioma did not result in significantly higher rates of MMSE decline than RT alone or observation. There was a trend towards an MMSE decline of ≥ 2 points at year 1 predicting for worse OS.    [Table: see text]

scholarly journals Glioma with Leptomeningeal Spread Mimics Chronic Meningoencephalitis in a Young Adult

2021 ◽  
pp. 179-183
Author(s):  
Ann-Kristin Becker ◽  
Marta Leonora Frank ◽  
Michael Friese ◽  
Joachim Röther
Keyword(s):  
Brain Tumor ◽  
Back Pain ◽  
Young Adult ◽  
Lower Back Pain ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Who Grade ◽  
Leptomeningeal Spread ◽  
Lower Back ◽  
Uncommon Case

The most malignant type of intrinsic brain tumor is glioblastoma (WHO grade IV). Primary leptomeningeal spread is rare and leads to a variety of differential considerations, as there is no typical clinical or imaging pattern. Here we present a rare and uncommon case of a primary leptomeningeal glioblastoma in combination with a low-grade glioma in a 21-year-old male, initially presenting with only headache and lower back pain. The presented case illustrates the challenging differential considerations and the severe course of leptomeningeal glioblastomas.

scholarly journals Management of low-grade glioma: a systematic review and meta-analysis

2018 ◽  
Vol 6 (4) ◽  
pp. 249-258 ◽  
Author(s):  
Timothy J Brown ◽  
Daniela A Bota ◽  
Martin J van Den Bent ◽  
Paul D Brown ◽  
Elizabeth Maher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
World Health ◽  
Subtotal Resection ◽  
Low Grade ◽  
Evidence Based ◽  
Free Survival ◽  
Low Grade Gliomas

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.

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