Updated Therapeutic Strategy for Adult Low-Grade Glioma Stratified by Resection and Tumor Subtype

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概要

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• The importance of surgical resection for patients with supratentorial low-grade glioma (LGG) remains controversial. This retrospective study of patients (n = 153) treated between 2000 to 2010 at a single institution assessed whether increasing the extent of resection (EOR) was associated with improved progression-free survival (PFS) and overall survival (OS). Histological subtypes of World Health Organization grade II tumors were as follows: diffuse astrocytoma in 49 patients (32.0%), oligoastrocytoma in 45 patients (29.4%), and oligodendroglioma in 59 patients (38.6%). Median pre- and postoperative tumor volumes and median EOR were 29.0 cm3 (range 0.7-162 cm3) and 1.7 cm3 (range 0-135.7 cm3) and 95%, respectively. Five- and 10-year OS for all LGG patients were 95.1% and 85.4%, respectively. Eight-year OS for diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma were 70.7%, 91.2%, and 98.3%, respectively. Five-year PFS for diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma were 42.6%, 71.3%, and 62.7%, respectively. Patients were divided into two groups by EOR ≥90% and <90%, and OS and PFS were analyzed. Both OS and PFS were significantly longer in patients with ≥90% EOR. Increased EOR resulted in better PFS for diffuse astrocytoma but not for oligodendroglioma. Multivariate analysis identified age and EOR as parameters significantly associated with OS. The only parameter associated with PFS was EOR. Based on these findings, we established updated therapeutic strategies for LGG. If surgery resulted in EOR <90%, patients with astrocytoma will require second-look surgery, whereas patients with oligodendroglioma or oligoastrocytoma, which are sensitive to chemotherapy, will be treated with chemotherapy.

著者

• Mitsuhashi Norio

  Department Of Cardiology Tokyo Women's Medical University

• Saito Taichi

  Department Of Orthopaedic Surgery Graduate School Of Medical Sciences Kyushu University

• Okada Yoshikazu

  Department Of Medical Informatics Tokai University School Of Medicine

• Iseki Hiroshi

  Department Of Neurosurgery Neurological Institute Tokyo Women's Medical College

• Maebayashi Katsuya

  Department Of Radiation Oncology Tokyo Women's Medical University School Of Medicine

• Tamura Manabu

  Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Wo

• Nitta Masayuki

  Department Of Neurosurgery Neurological Institute Tokyo Women's Medical University

• Watanabe Atsushi

  Department Of Biochemistry And Molecular Biology Nippon Medical School

• Maruyama Takashi

  Department Of Cardiovascular Surgery Hokkaido University School Of Medicine:department Of Pharmacolo

• Ikuta Soko

  Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Wo

• Konishi Yoshiyuki

  Faculty Of Advanced Techno-surgery Institute Of Advanced Biomedical Engineering And Science Tokyo Women's Medical University

• MURAGAKI Yoshihiro

  Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University

• CHERNOV Michael

  Faculty of Advanced Techno-Surgery, Graduate School of Medicine, Tokyo Women's Medical University

• OKAMOTO Saori

  Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University

• OKAMOTO Saori

  Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University

• CHERNOV Michael

  Faculty of Advanced Techno-Surgery, Graduate School of Medicine, Tokyo Women's Medical University

• MAEBAYASHI Katsuya

  Department of Radiation Oncology, Graduate School of Medicine, Tokyo Women's Medical University

• SAITO Taichi

  Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University

• MARUYAMA Takashi

  Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University

• KONISHI Yoshiyuki

  Faculty of Advanced Techno-Surgery, Graduate School of Medicine, Tokyo Women's Medical University

• TAMURA Manabu

  Faculty of Advanced Techno-Surgery, Graduate School of Medicine, Tokyo Women's Medical University

• NITTA Masayuki

  Department of Neurosurgery, Graduate School of Medicine, Tokyo Women's Medical University

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