Seizure outcomes and survival in adult low-grade glioma over 11 years: living longer and better

Abstract

Background: There has been a trend towards earlier and more aggressive resection for Low-Grade Gliomas (LGG). This study set out to compare seizure control and survival of adults with LGG seen in the same neuro-oncology clinic over 11 years and to determine if a change in surgical philosophy has led to a corresponding improvement in outcomes.Methods: Retrospective analysis using case-note review of 153 adults with histologically verified or radiologically suspected LGG, collecting data on patient, tumor and seizure characteristics between 2006 and 2017. Results:We studied 79 patients in 2006 and 74 patients in 2017. There was no significant difference between the two groups in age at presentation, tumor location or integrated pathological diagnosis. The numbers of complete or partial resections increased from 21.5 % in 2006 to 60.8% in 2017 (p<0.05). Five and Ten-year Overall Survival increased from 81.8% and 51.7% in 2006 to 100% and 95.8% in 2017 (p<0.001); similarly Five and Ten -year Progression-Free Survival increased from 47.0% and 30.7% in 2006 to 93.1% and 68.7% in 2017. The proportion of patients with intractable epilepsy reduced from 72.2% in 2006 to 43.2% in 2017 (p<0.05). The neurosurgical morbidity rate was identical in both groups (11.8% in 2006 vs 11.1% in 2017) Conclusion: Management of LGG over the last eleven years has led to substantial improvements in survival and seizure control. This is most likely to be due to a change in surgical philosophy with early resection now favored over watchful waiting where possible.