Adult Supratentorial Low-Grade Glioma: Long-Term Experience at a Single Institution
To report the long-term follow-up of a cohort of adult patients with supratentorial low-grade glioma treated at a single institution.
A cohort of 145 adult patients treated at the London Regional Cancer Program between 1979 and 1995 was reviewed.
With a median follow-up of 105 months, the median progression-free survival was 61 months (95% confidence interval, 53-77), and the median overall survival was 118 months (95% confidence interval, 93-129). The 10- and 20-year progression-free and overall survival rate was 18% and 0% and 48% and 22%, respectively. Cox regression analysis confirmed the importance of age, histologic type, presence of seizures, Karnofsky performance status, and initial extent of surgery as prognostic variables for overall and cause-specific survival. Function among long-term survivors without tumor progression was good to excellent for most patients.
Low-grade glioma is a chronic disease, with most patients dying of their disease. However, long-term survival with good function is possible. Survival is determined primarily by the disease factors with selection and timing of adjuvant treatments having less influence on outcome.
Available from: Parisa Azimi
- "In the study by Kevin et al., only 7% of patients had grade II astrocytoma and 55% had grade I with a mean age of 8.7 years for patients, which might again contribute to their good reported results. Bauman et al. (26) reported a long-term (20 years) treatment of supratentorial LGGs with surgery, RT and chemotherapy, either separately or in combination, with a median follow-up of 105 months. The median PFS was 61 months (95% confidence interval: 53–77), and the median OS was 118 months (95% confidence interval: 93 – 129). "
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ABSTRACT: Treatment of low-grade astrocytoma (WHO grade II) (LGA II) remains a challenge. There is limited information regarding the long-term effects of stereotactic brachytherapy (SBT) (temporary (125)Iodine seeds) on patients with LGA II.
The purpose of this study was to evaluate disease control and survival after stereotactic brachytherapy in patients with circumscribed and relatively small size tumors.
A retrospective review of 29 patients, treated between 1991 and 2011, was conducted to evaluate survival, complications, and local disease control after stereotactic brachytherapy. They belonged to a larger group of 48 cases with low-grade gliomas, treated with stereotactic brachytherapy. The demographic and clinical characteristics in patients including age, sex, and survival time were extracted from records.
Thirteen patients were male and 16 were female, with the median age of 29 years (range, 2.5 - 64 years). The median follow-up was 95 (range, 6 - 240) months. Based on Pignatti classification, 10 patients were at low- and 19 patients at high-risk. The median overall as well as progression-free survivals for patients were 135 months (95% confidence interval: 76 - 194) and 96 months (95% confidence interval: 1 - 199), respectively. Five- and 10-year progression-free survivals were 41.4 % and 34.5 %, respectively, and the 5- and 10-year overall survivals were 65.5 % and 44.8%, respectively. Progression-free survival was not significantly higher in smaller size tumors (P = 0.224), nor for spherical versus non-spherical tumors (P = 0.307). There was no treatment-related morbidity after stereotactic brachytherapy, and no radiogenic complications occurred during the follow-up period. Mortality due to tumor progression occurred in 4 patients (14%), and 11 patients were alive at the last follow-up.
The stereotactic brachytherapy for patients with circumscribed and relatively small size tumors appears to be a safe, feasible, and minimally-invasive treatment.
Available from: John Y K Lee
- "PFS, OS Tumor location in cortex, age, tumor size, KPS Bauman 2009 18 Retrospective 145 CSS, OS Age, histology, KPS, extent of surgery, neurologic deficits (seizure) Capelle 2009 19 "
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ABSTRACT: The role of postoperative radiotherapy (PORT) in the management of low-grade glioma remains controversial. An analysis using data from the European Organization for Research and Treatment of Cancer 22844/22845 studies concluded that several factors portend a poor prognosis: age ≥40 years, astrocytoma histology, tumor size ≥6 cm, tumor crossing midline, and preoperative neurologic deficits. PORT may benefit patients with high-risk features. The aim of this study was to assess temporal trends and determinants of the use of PORT.
By using data from the Surveillance, Epidemiology, and End Results program, the authors identified 1127 adult patients diagnosed with low-grade glioma (World Health Organization grade I and II) who underwent surgical resection between January 1, 1998 and December 31, 2006. The primary outcome was receipt of PORT. The authors performed multivariate logistic regression to examine the association between clinical, patient, and demographic characteristics and receipt of PORT.
Receipt of PORT declined during the study period, from 64% of patients in 1998 to 36% of patients in 2006. On multivariate analysis, significant predictors of receipt of PORT were age ≥40 years, tumor crossing midline, and partial surgical resection.
The use of PORT for patients with low-grade glioma has declined in the period from 1998 to 2006 for both low-risk and high-risk patients.
Available from: Nader Pouratian
- "The most important negative prognostic factors to emerge from the literature include increasing age, astrocytic histology, large tumor diameter (>4–6 cm), tumors crossing the midline, neurologic deficits, and poor performance status [2, 4–6, 7•, 8, 9]. In contrast, presentation with seizures, which generally occur in patients who are otherwise neurologically intact, often is identified as a positive prognostic factor [5, 8, 9]. "
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ABSTRACT: The optimal management of patients with low-grade glioma (LGG) is controversial. The controversy largely stems from the lack of well-designed clinical trials with adequate follow-up to account for the relatively long progression-free survival and overall survival of patients with LGG. Nonetheless, the literature increasingly suggests that expectant management is no longer optimal. Rather, there is mounting evidence supporting active management including consideration of surgical resection, radiotherapy, chemotherapy, molecular and histopathologic characterization, and use of modern imaging techniques for monitoring and prognostication. In particular, there is growing evidence favoring extensive surgical resection and increasing interest in the role of chemotherapy (especially temozolomide) in the management of these tumors. In this review, we critically analyze emerging trends in the literature with respect to management of LGG, with particular emphasis on reports published during the past year.
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