Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection

Masayuki Nitta, Yoshihiro Muragaki, Takashi Maruyama, Soko Ikuta, Takashi Komori, Katsuya Maebayashi, Hiroshi Iseki, Manabu Tamura, Taiichi Saito, Saori Okamoto, Mikhail Chernov, Motohiro Hayashi, Yoshikazu Okada

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status. METHODS One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy. RESULTS Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS. CONCLUSIONS The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection.

Original languageEnglish
Pages (from-to)E7
JournalNeurosurgical Focus
Volume38
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1
Externally publishedYes

Fingerprint

Glioma
Neoplasms
Drug Therapy
Therapeutics
Radiotherapy
Astrocytoma
Biopsy
Survival
Tokyo
Disease-Free Survival
Multivariate Analysis
Retrospective Studies

Keywords

  • ACNU = nimustine hydrochloride
  • EOR = extent of resection
  • EORTC = European Organisation for Research and Treatment of Cancer
  • LGG = low-grade glioma
  • low-grade glioma
  • OS = overall survival
  • PCV = procarbazine, lomustine, vincristine
  • PFS = progression-free survival
  • RT = radiotherapy
  • surgical resection
  • survival
  • therapeutic strategy
  • tumor subtype

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Nitta, M., Muragaki, Y., Maruyama, T., Ikuta, S., Komori, T., Maebayashi, K., ... Okada, Y. (2015). Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection. Neurosurgical Focus, 38(1), E7. https://doi.org/10.3171/2014.10.FOCUS14651

Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection. / Nitta, Masayuki; Muragaki, Yoshihiro; Maruyama, Takashi; Ikuta, Soko; Komori, Takashi; Maebayashi, Katsuya; Iseki, Hiroshi; Tamura, Manabu; Saito, Taiichi; Okamoto, Saori; Chernov, Mikhail; Hayashi, Motohiro; Okada, Yoshikazu.

In: Neurosurgical Focus, Vol. 38, No. 1, 01.01.2015, p. E7.

Research output: Contribution to journalArticle

Nitta, M, Muragaki, Y, Maruyama, T, Ikuta, S, Komori, T, Maebayashi, K, Iseki, H, Tamura, M, Saito, T, Okamoto, S, Chernov, M, Hayashi, M & Okada, Y 2015, 'Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection', Neurosurgical Focus, vol. 38, no. 1, pp. E7. https://doi.org/10.3171/2014.10.FOCUS14651
Nitta, Masayuki ; Muragaki, Yoshihiro ; Maruyama, Takashi ; Ikuta, Soko ; Komori, Takashi ; Maebayashi, Katsuya ; Iseki, Hiroshi ; Tamura, Manabu ; Saito, Taiichi ; Okamoto, Saori ; Chernov, Mikhail ; Hayashi, Motohiro ; Okada, Yoshikazu. / Proposed therapeutic strategy for adult low-grade glioma based on aggressive tumor resection. In: Neurosurgical Focus. 2015 ; Vol. 38, No. 1. pp. E7.
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AU - Nitta, Masayuki

AU - Muragaki, Yoshihiro

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AU - Ikuta, Soko

AU - Komori, Takashi

AU - Maebayashi, Katsuya

AU - Iseki, Hiroshi

AU - Tamura, Manabu

AU - Saito, Taiichi

AU - Okamoto, Saori

AU - Chernov, Mikhail

AU - Hayashi, Motohiro

AU - Okada, Yoshikazu

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N2 - OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status. METHODS One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy. RESULTS Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS. CONCLUSIONS The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection.

AB - OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status. METHODS One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy. RESULTS Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS. CONCLUSIONS The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection.

KW - ACNU = nimustine hydrochloride

KW - EOR = extent of resection

KW - EORTC = European Organisation for Research and Treatment of Cancer

KW - LGG = low-grade glioma

KW - low-grade glioma

KW - OS = overall survival

KW - PCV = procarbazine, lomustine, vincristine

KW - PFS = progression-free survival

KW - RT = radiotherapy

KW - surgical resection

KW - survival

KW - therapeutic strategy

KW - tumor subtype

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