Clinical characteristics associated with postoperative seizure control in adult low-grade gliomas: 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.

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Clinical and molecular genetic factors affecting postoperative seizure control of 183 Chinese adult patients with low-grade gliomas

European Journal of Neurology ◽

10.1111/j.1468-1331.2011.03509.x ◽

2011 ◽

Vol 19 (2) ◽

pp. 298-306 ◽

Cited By ~ 26

Author(s):

G. You ◽

L. Huang ◽

P. Yang ◽

W. Zhang ◽

W. Yan ◽

...

Keyword(s):

Genetic Factors ◽

Seizure Control ◽

Molecular Genetic ◽

Adult Patients ◽

Low Grade ◽

Factors Affecting ◽

Low Grade Gliomas ◽

Chinese Adult ◽

Postoperative Seizure

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Seizure Characteristics and Postoperative Seizure Control in Patients with Low-grade Gliomas

Neurosurgery ◽

10.1093/neurosurgery/57.2.430 ◽

2005 ◽

Vol 57 (2) ◽

pp. 430-430 ◽

Cited By ~ 1

Author(s):

Edward F. Chang ◽

Evren G. Keles ◽

Matt Potts ◽

Susan Chang ◽

Kathleen L. Lamborn ◽

...

Keyword(s):

Seizure Control ◽

Low Grade ◽

Low Grade Gliomas ◽

Postoperative Seizure

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Amide proton transfer-weighted MRI in distinguishing high- and low-grade gliomas: a systematic review and meta-analysis

Neuroradiology ◽

10.1007/s00234-018-02152-2 ◽

2019 ◽

Vol 61 (5) ◽

pp. 525-534 ◽

Cited By ~ 10

Author(s):

Chong Hyun Suh ◽

Ji Eun Park ◽

Seung Chai Jung ◽

Choong Gon Choi ◽

Sang Joon Kim ◽

...

Keyword(s):

Systematic Review ◽

Proton Transfer ◽

Meta Analysis ◽

Amide Proton ◽

Low Grade ◽

Low Grade Gliomas ◽

Amide Proton Transfer

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The Prevalence of BRAF Mutations in Patients with Glioma: A Systematic Review

Neuro-Oncology ◽

10.1093/neuonc/noz167.056 ◽

2019 ◽

Vol 21 (Supplement_4) ◽

pp. iv13-iv13

Author(s):

Saanwalshah Samir Saincher ◽

Julian P T Higgins ◽

Alexandra McAleenan ◽

Kathreena M Kurian

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Age Groups ◽

Low Grade ◽

Braf Inhibitors ◽

Braf Mutations ◽

Low Grade Gliomas ◽

Promising Area ◽

Oncogene Homologue ◽

Murine Sarcoma

Abstract Background The V600mutation in the v-raf murine sarcoma oncogene homologue B1 (BRAF) enzyme, is a potential clinically actionable target in gliomas. BRAF inhibitors are in wide clinical use for other tumour types, particularly melanoma. The prevalence of this mutation across all gliomas is not fully elucidated and is needed to inform potential screening and treatment. Methods A systematic review using articles on the MEDLINE and EMBASE databases (February 1, 2019) was carried out. A meta-analysis was conducted to calculate the prevalence of BRAF mutations in patients with gliomas across all populations and age groups in a clinical setting. Preliminary Results The review identified 75 studies including 6316 patients; the ages of participants ranged from 30 days to 90 years with a mean age of 32.75 years. Across all studies, the average prevalence of BRAF mutations was 16% (95% confidence interval (CI) from 12% to 20%) but estimates were highly variable across studies, ranging from 0% to 78%. The average prevalence of BRAF mutations in paediatric group was 15% (95% CI 10% to 20%) while the average prevalence in the adult group was 9% (95% CI 4% to 16%). Low grade gliomas had an average prevalence of 19% (95% CI 14% to 25%) compared with 7% (95% CI 4% to 11%) in high-grade gliomas. Conclusions BRAF mutations were found to be more prevalent in pediatric patients and in low grade gliomas. Screening these patients for BRAF mutations and treating them with BRAF inhibitors represents a promising area of future medical practice.

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Seizures in Patients Undergoing Resection of Low-Grade Gliomas

Epilepsy Currents ◽

10.1111/j.1535-7511.2009.01305.x ◽

2009 ◽

Vol 9 (4) ◽

pp. 98-100 ◽

Cited By ~ 4

Author(s):

Lawrence J. Hirsch

Keyword(s):

Multivariate Analysis ◽

Seizure Control ◽

Gross Total Resection ◽

Subtotal Resection ◽

Low Grade ◽

Total Resection ◽

Meaningful Improvement ◽

Low Grade Gliomas ◽

Initial Surgery ◽

Postoperative Seizure

Seizure Characteristics and Control Following Resection in 332 Patients with Low-Grade Gliomas. Chang EF, Potts MB, Keles GE, Lamborn KR, Chang SM, Barbaro NM, Berger MS. J Neurosurg 2008;108(2):227–235. OBJECT: Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. METHODS: The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. RESULTS: Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively ( p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer ( p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history ( p < 0.001) and simple partial seizures ( p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2–124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression ( p = 0.001). CONCLUSIONS: The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

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Seizure characteristics and control following resection in 332 patients with low-grade gliomas

Journal of Neurosurgery ◽

10.3171/jns/2008/108/2/0227 ◽

2008 ◽

Vol 108 (2) ◽

pp. 227-235 ◽

Cited By ~ 331

Author(s):

Edward F. Chang ◽

Matthew B. Potts ◽

G. Evren Keles ◽

Kathleen R. Lamborn ◽

Susan M. Chang ◽

...

Keyword(s):

Multivariate Analysis ◽

Seizure Control ◽

Gross Total Resection ◽

Subtotal Resection ◽

Low Grade ◽

Total Resection ◽

Meaningful Improvement ◽

Low Grade Gliomas ◽

Initial Surgery ◽

Postoperative Seizure

Object Seizures play an important role in the clinical presentation and postoperative quality of life of patients who undergo surgical resection of low-grade gliomas (LGGs). The aim of this study was to identify factors that influenced perioperative seizure characteristics and postoperative seizure control. Methods The authors performed a retrospective chart review of all cases involving adult patients who underwent initial surgery for LGGs at the University of California, San Francisco between 1997 and 2003. Results Three hundred and thirty-two cases were included for analysis; 269 (81%) of the 332 patients presented with ≥ 1 seizures (generalized alone, 33%; complex partial alone, 16%; simple partial alone, 22%; and combination, 29%). Cortical location and oligodendroglioma and oligoastrocytoma subtypes were significantly more likely to be associated with seizures compared with deeper midline locations and astrocytoma, respectively (p = 0.017 and 0.001, respectively; multivariate analysis). Of the 269 patients with seizures, 132 (49%) had pharmacoresistant seizures before surgery. In these patients, seizures were more likely to be simple partial and to involve the temporal lobe, and the period from seizure onset to surgery was likely to have been longer (p = 0.0005, 0.0089, and 0.006, respectively; multivariate analysis). For the cohort of patients that presented with seizures, 12-month outcome after surgery (Engel class) was as follows: seizure free (I), 67%; rare seizures (II), 17%; meaningful seizure improvement (III), 8%; and no improvement or worsening (IV), 9%. Poor seizure control was more common in patients with longer seizure history (p < 0.001) and simple partial seizures (p = 0.004). With respect to treatment-related variables, seizure control was far more likely to be achieved after gross-total resection than after subtotal resection/biopsy alone (odds ratio 16, 95% confidence interval 2.2–124, p = 0.0064). Seizure recurrence after initial postoperative seizure control was associated with tumor progression (p = 0.001). Conclusions The majority of patients with LGG present with seizures; in approximately half of these patients, the seizures are pharmacoresistant before surgery. Postoperatively, > 90% of these patients are seizure free or have meaningful improvement. A shorter history of seizures and gross-total resection appear to be associated with a favorable prognosis for seizure control.

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