Adult low-grade glioma: 19-year experience at a single institution

Abstract

Objectives: To determine prognostic factors and optimal timing of postoperative radiation therapy (RT) in adult low-grade gliomas.

Methods: Records from 554 adults diagnosed with nonpilocytic low-grade gliomas at Mayo Clinic between 1992 and 2011 were retrospectively reviewed.

Results: Median follow-up was 5.2 years. Histology revealed astrocytoma in 22%, oligoastrocytoma in 34%, and oligodendroglioma in 45%. Initial surgery achieved gross total resection in 31%, radical subtotal resection in 10%, subtotal resection (STR) in 21%, and biopsy only in 39%. Median overall survival (OS) and progression-free survival (PFS) were 11.4 and 4.1 years, respectively. On multivariate analysis, factors associated with lower OS included astrocytomas and use of postoperative RT. Adverse prognostic factors for PFS on multivariate analysis included tumor size, astrocytomas, STR/biopsy only and not receiving RT. Patients undergoing gross total resection/radical subtotal resection had the best OS and PFS. Comparing survival with the log-rank test demonstrated no association between RT and PFS (P=0.24), but RT was associated with lower OS (P<0.0001). In patients undergoing STR/biopsy only, RT was associated with improved PFS (P<0.0001) but lower OS (P=0.03). Postoperative RT was associated with adverse prognostic factors including age > 40 years, deep tumors, size≥5 cm, astrocytomas and STR/biopsy only. Patients delaying RT until recurrence experienced 10-year OS (71%) similar to patients never needing RT (74%; P=0.34).

Conclusions: This study supports the association between aggressive surgical resection and better OS and PFS, and between postoperative RT and improved PFS in patients receiving STR/biopsy only. In addition, our findings suggest that delaying RT until progression is safe in patients who are eligible.

FIGURE 1

Progression-free survival (A) and overall survival (B) for all 554 patients studied.

FIGURE 2

Progression-free survival (A) and overall survival (B) based on extent of resection. Also seen is progression-free survival (C) and overall survival (D) based on the use of postoperative RT. GTR indicates gross total resection; rSTR, radical subtotal resection; RT, radiation therapy; STR, subtotal resection.

FIGURE 3

Progression-free survival (A) and overall survival (B) by postoperative RT in patients undergoing GTR/rSTR. Also seen is progression-free survival (C) and overall survival (D) by postoperative RT in patients undergoing STR/biopsy only. GTR indicates gross total resection; rSTR, radical subtotal resection; RT, radiation therapy; STR, subtotal resection.

FIGURE 4

Overall survival in patients based on histology (A). Overall survival comparing time of RT administration (B). RT indicates radiation therapy.