Eighty percent survival rate at 15 years for 1p/19q co-deleted oligodendroglioma treated with upfront chemotherapy irrespective of tumor grade

Iwadate, Yasuo; Matsutani, Tomoo; Hara, Atsushi; Hirono, Shuichi; Ikegami, Shiro; Kobayashi, Masayoshi; Ito, Daisuke; Kawauchi, Daisuke; Horiguchi, Kentaro; Tamiya, Ado; Higuchi, Yoshinori

doi:10.1007/s11060-018-03027-5

Cited by 21 publications

(13 citation statements)

References 37 publications

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“…Today, personalized medicine approaches according to molecular and epigenetic tumor data tailor adjuvant treatment for patients with lower grade gliomas [2,3]. With refinements in therapy and improvements in life expectancy, [4][5][6] the perception of glioma gradually shifts from a lethal to a chronic disease, with median survival times ranging between 5 and 15 years [6][7][8][9]. Therefore, effects of therapeutic interventions on patients' quality of life have gained interest in recent years [10,11].…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

The ability to return to work: a patient-centered outcome parameter following glioma surgery

et al. 2020

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Background With refinements in diagnosis and therapy of gliomas, the importance of survival time as the sole outcome parameter has decreased, and patient-centered outcome parameters have gained interest. Pursuing a profession is an indispensable component of human happiness. The aim of this study was to analyze the professional outcomes besides their neuro-oncological and functional evaluation after surgery for gliomas in eloquent areas. Methods We assessed neuro-oncological and functional outcomes of patients with gliomas WHO grades II and III undergoing surgery between 2012 and 2018. All patients underwent routine follow-up and adjuvant treatment. Treatment and survival parameters were collected prospectively. Repercussions of the disease on the patients’ professional status, socio-economic situation, and neurocognitive function were evaluated retrospectively with questionnaires. Results We analyzed data of 58 patients with gliomas (WHO II: 9; III: 49). Median patient age was 35.8 years (range 21–63 years). Awake surgery techniques were applied in 32 patients (55.2%). Gross total and subtotal tumor resections were achieved in 33 (56.9%) and 17 (29.3%) patients, respectively, whereas in 8 patients (13.8%) resection had to remain partial. Most patients (n = 46; 79.3%) received adjuvant treatment. Median follow up was 43.8 months (range 11–82 months). After treatment 41 patients (70.7%) were able to resume a working life. Median time until returning to work was 8.0 months (range 0.2–22.0 months). To be younger than 40 at the time of the surgery was associated with a higher probability to return to work (p < .001). Multivariable regression analysis showed that patient age < 40 years as well as occupational group and self-reported fatigue were factors independently associated with the ability to return to work. Conclusion The ability to resume professional activities following brain tumor surgery is an important patient-oriented outcome parameter. We found that the majority of patients with gliomas were able to return to work following surgical and adjuvant treatment. Preservation of neurological function is of utmost relevance for individual patients´ quality of life.

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Section: Electronic Supplementary Materialsmentioning

confidence: 99%

The ability to return to work: a patient-centered outcome parameter following glioma surgery

et al. 2020

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“…O ligOdendrOgliOmas, historically stratified by histological criteria into grade II (O2) or grade III (O3) tumors, are now currently classified and diagnosed using a molecular signature: mutations in the isocitrate dehydrogenase (IDH) gene family and chromosomal 1p/19q codeletion. IDH mutations are thought to be an early, nearly ubiquitous prerequisite in the development of oligodendroglioma, 1,2 and their presence carries prognostic significance for progression-free and overall survival (OS), 3,4 as well as other outcome-related measures such as seizure control, 5 better response to radio-/chemotherapy, [6][7][8] recurrence, 9 and even present targets for oncological vaccination. 47 Whole-arm chromosomal loss of 1p/19q is invariably associated with IDH mutations, and IDH mutation may even be a prerequisite for its translocation.…”

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confidence: 99%

Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas

Garton

Kinslow

Rae

et al. 2021

Journal of Neurosurgery

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OBJECTIVEGenomic analysis in neurooncology has underscored the importance of understanding the patterns of survival in different molecular subtypes within gliomas and their responses to treatment. In particular, diffuse gliomas are now principally characterized by their mutation status (IDH1 and 1p/19q codeletion), yet there remains a paucity of information regarding the prognostic value of molecular markers and extent of resection (EOR) on survival. Furthermore, given the modern emphasis on molecular rather than histological diagnosis, it is important to examine the effect of maximal resection on survival in all gliomas with 1p/q19 codeletions, as these will now be classified as oligodendrogliomas under the new WHO guidelines.The objectives of the present study were twofold: 1) to assess the association between EOR and survival for patients with oligodendrogliomas in the National Cancer Database (NCDB), which includes information on mutation status, and 2) to demonstrate the same effect for all patients with 1p/19q codeleted gliomas in the NCDB.METHODSThe NCDB was queried for all cases of oligodendroglioma between 2004 and 2014, with follow-up dates through 2016. The authors found 2514 cases of histologically confirmed oligodendrogliomas for the final analysis of the effect of EOR on survival. Upon further query, 1067 1p/19q-codeleted tumors were identified in the NCDB. Patients who received subtotal resection (STR) or gross-total resection (GTR) were compared to those who received no tumor debulking surgery. Univariable and multivariable analyses of both overall survival and cause-specific survival were performed.RESULTSEOR was associated with increased overall survival for both histologically confirmed oligodendrogliomas and all 1p/19q-codeleted–defined tumors (p < 0.001 and p = 0.002, respectively). Tumor grade, location, and size covaried predictably with EOR. When evaluating tumors by each classification system for predictors of overall survival, facility setting, age, comorbidity index, grade, location, chemotherapy, and radiation therapy were all shown to be significantly associated with overall survival. STR and GTR were independent predictors of improved survival in historically classified oligodendrogliomas (HR 0.83, p = 0.18; HR 0.69, p = 0.01, respectively) and in 1p/19q-codeleted tumors (HR 0.49, p < 0.01; HR 0.43, p < 0.01, respectively).CONCLUSIONSBy using the NCDB, the authors have demonstrated a side-by-side comparison of the survival benefits of greater EOR in 1p/19q-codeleted gliomas.

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“…Here, despite the relatively small sample size, we found an association between EOR of the T2 FLAIR disease and progression free survival. Several studies have suggested that chemotherapy without upfront radiation may be a viable option for patients with grade II oligodendrogliomas [16][17][18]; this also may hold true for patients diagnosed with anaplastic oligodendroglioma [19]. One major benefit of prolonging the use of radiation in patients would be limiting the potential negative long term effects of radiation, including potential cognitive [7,9] and some emerging evidence suggests it may alter wide scale functional connectivity [20].…”

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confidence: 99%

A single institution retrospective analysis on survival based on treatment paradigms for patients with anaplastic oligodendroglioma

et al. 2021

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Introduction Anaplastic oligodendrogliomas are high-grade gliomas defined molecularly by 1p19q co-deletion. There is no curative therapy, and standard of care includes surgical resection followed by radiation and chemotherapy. However, the benefit of up-front radiation with chemotherapy compared to chemotherapy alone has not been demonstrated in a randomized control trial. Given the potential long-term consequences of radiation therapy, such as cognitive impairment, arteriopathy, endocrinopathy, and hearing/visual impairment, there is an effort to balance longevity with radiation toxicity. Methods We performed a retrospective single institution analysis of survival of patients with anaplastic oligodendroglioma over 20 years. Results 159 patients were identified as diagnosed with an anaplastic oligodendroglioma between 1996 and 2016. Of those, 40 patients were found to have AO at original diagnosis and had documented 1p19q co-deletion with a median of 7.1 years of follow-up (range: 0.6–16.7 years). After surgery, 45 % of patients were treated with radiation and chemotherapy at diagnosis, and 50 % were treated with adjuvant chemotherapy alone. The group treated with chemotherapy alone had a trend of receiving more cycles of chemotherapy than patients treated with radiation and chemotherapy upfront (p = 0.051). Median overall survival has not yet been reached. The related risk of progression in the upfront, adjuvant chemotherapy only group was almost 5-fold higher than the patients who received radiation and chemotherapy (hazard ratio = 4.85 (1.74–13.49), p = 0.002). However, there was no significant difference in overall survival in patients treated with upfront chemotherapy compared to patients treated upfront with chemotherapy and radiation (p = 0.8). Univariate analysis of age, KPS, extent of resection, or upfront versus delayed radiation was not associated with improved survival. Conclusions Initial treatment with adjuvant chemotherapy alone, rather than radiation and chemotherapy, may be an option for some patients with anaplastic oligodendroglioma, as it is associated with similar overall survival despite shorter progression free survival.

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Eighty percent survival rate at 15 years for 1p/19q co-deleted oligodendroglioma treated with upfront chemotherapy irrespective of tumor grade

Cited by 21 publications

References 37 publications

The ability to return to work: a patient-centered outcome parameter following glioma surgery

The ability to return to work: a patient-centered outcome parameter following glioma surgery

Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas

A single institution retrospective analysis on survival based on treatment paradigms for patients with anaplastic oligodendroglioma

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