Association Between the Extent of Resection and Prognosis in Adult Patients With WHO Grade III Gliomas: a Population-based Study

PurposeThe role of surgical resection in the treatment of anaplastic glioma is poorly understood. The aim of the present retrospective study was to clarify the survival of patients with anaplastic gliomas.MethodsWe utilized the SEER database to assess the association between prognostic and demographic data, tumor characteristics, and treatment factors in adult patients with anaplastic glioma. Overall survival and cause-specific survival were analyzed using multivariable Cox regression and competing risk regression, respectively.ResultsA total of 3979 patients with anaplastic glioma who had undergone surgical intervention were included in the analysis. Patients who underwent gross total resection (GTR) had significantly better 5-year and 10-year overall survival (OS) (59.9% vs. 44.0%, 45.0% vs. 29.4%, p < 0.001) than those who did not. The 5-year and 10-year cumulative incidence rates of cancer-specific death in the GTR group were lower than those in the corresponding N-GTR group (36.6% vs.51.9%, 49.9% vs. 65.5%, p < 0.001). Multivariable analysis identified GTR as an independent significant predictor for prolonged OS (HR:0.72; 95% confidence interval [CI] 0.65-0.79, P<0.05) and cause-specific survival (CSS) (HR:0.72, 95% CI 0.65-0.80, P<0.05).Further subgroup analysis revealed a stable association between the extent of resection and OS (P values for interaction >0.05), except for tumor location and histologic type groups.ConclusionsWhile the survival of patients with anaplastic glioma remains poor, GTR is associated with increased OS and CSS compared to N-GTR.

Advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma

The possibility of using only tractography as a preoperative diagnosis of anaplastic glioma is limited due to its inability to show the exact functional location of the tumor; therefore, the combination of tractography and fMRI seems to be a more promising complex diagnostic method. In neurooncology, complete resection without or with minimal neurological deficit is the goal of surgical intervention. The aim of the study was to investigate the advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma compared to standard CT or MRI. The study involved 48 patients who were divided into two groups based on the use of fMRI and tractography: group A (24 patients) and without it — group B (24 patients). The groups were compared in terms of age, sex, histological subtype of anaplastic glioma, degree of resection, postoperative complications, and dynamics of neurological disorders. The combination of fMRI and tractography is the best preoperative diagnosis, it is safe and allows localizing neural pathways, preserve them during surgery, and reduce postoperative neurological deficits.

Large Tumour Volume Reduction of Idh Mutated Anaplastic Glioma Involving the Insular Region Following Radiation Therapy: an Alternative to Maximal Surgical Resection

Background: In IDH-mutated anaplastic glioma (IDHmutAG) of the insular cortex there remains uncertainty of benefit with near-total resection compared to limited surgery with radiation therapy (IMRT). This study aimed to assess tumour volume reduction in patients following IMRT and impact of residual post-surgical volume. Methods and Materials:Patients with IDHmutAG involving insular cortex managed with IMRT from 2008-2019 had baseline patient, tumour and treatment factors recorded. Volumetric assessment of residual disease on MRI was performed at baseline, month+3 and month+12 post-IMRT. Potential prognostic factors were analysed for tumour reduction and relapse-free survival, and assessed by log-rank and Cox regression analyses. Results: 32 patients with IDHmutAG of the insular cortex were managed with median follow-up post-IMRT of 67.2 months. Pathology was anaplastic astrocytoma (AAmut) in 20, and anaplastic oligodendroglioma (AOD) in 12 patients. Median pre-IMRT volume on T1 and T2Flair was 24.3cm3 and 52.2cm3. Twenty-seven patients were alive with 5-year relapse-free survival of 80%. There was a median 67% and 64% reduction from baseline occurring at 3 months post-IMRT for T1 and T2Flair respectively; and subsequent median 78% and 73% at 12 months. At 12 months AOD patients had median 83% T1 volume reduction compared to 63% in AAmut (p<0.01). There was no difference on T2Flair volume (p=0.64). No other pathological factors influenced volume reduction at 12 months. No factors were associated with relapse-free survival including baseline T1 (p=0.52) and T2Flair (p=0.93) volume.Conclusion:IMRT provides large tumour volume reduction in IDHmutAG of the insular cortex with no significant negative impact of residual disease volume on relapse-free survival.

Factors affecting the transformation of anaplastic glioma into glioblastoma

Despite being more favorable than glioblastoma, even after complex treatment, anaplastic glioma mostly progresses and transforms into glioblastoma in case of recurrence. The aim of this research was to study the clinical picture, survival rate and factors affecting the transformation of anaplastic glioma into glioblastoma. We studied the patients with anaplastic glioma, whose tumors transformed into glioblastoma, retrospectively from 2002 to 2020. The clinical picture and overall survival rate were studied. A total of 101 patients with anaplastic glioma, of which 29 transformed into glioblastoma (17 men and 12 women, with an average age of 48 years), were studied. The average time of glioblastoma transformation was 31 months. The overall survival was 44.50 months. The survival rate after the transformation was 13.5 months. The transformation of anaplastic glioma into glioblastoma affects the treatment protocol of patients, since the transformation is most often detected after the histology of re-resection has been confirmed. The treatment of anaplastic glioma should be individualized, taking into account molecular markers, age, and resection degree. Further research should also focus on the prevention or early treatment of transformed gliomas.