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. 2018 Jan 15;8(1):777.
doi: 10.1038/s41598-017-19014-1.

Recurrence patterns after maximal surgical resection and postoperative radiotherapy in anaplastic gliomas according to the new 2016 WHO classification

Jung Ho Im  1 , Je Beom Hong  2 , Se Hoon Kim  3 , Junjeong Choi  4 , Jong Hee Chang  5 , Jaeho Cho  1 , Chang-Ok Suh  6
Affiliations

Recurrence patterns after maximal surgical resection and postoperative radiotherapy in anaplastic gliomas according to the new 2016 WHO classification

Jung Ho Im et al. Sci Rep. .

Abstract

We assessed the appropriateness of current radiotherapy volume for WHO grade III gliomas. The records of 73 patients with WHO grade III gliomas who received postoperative radiotherapy between 2001 and 2013 were retrospectively reviewed. Based on the 2016 WHO classification, 25/73 (34.2%) patients had anaplastic oligodendroglioma (AO), IDH-mutant and 1p/19q-codeleted; 11/73 (15.1%) patients had anaplastic astrocytoma, IDH-mutant; and 37/73 (50.7%) patients had anaplastic astrocytoma, IDH-wildtype. The extent of resection (EOR) was total in 43 patients (58.9%). The median follow-up time was 84 months. The 5-year overall survival was 65.4%. Of 31 patients with documented recurrences, 20 (64.5%) had infield gross tumor volume (GTV) failure, six (19.4%) had clinical target volume (CTV)/marginal failure, and five (16.1%) had outfield failure/seeding. In 13 recurrences among 43 patients who underwent gross total resection (GTR), six (46.2%) had infield CTV/marginal failure. However, among 30 patients for whom GTR was not conducted, infield GTV failure was dominant (77.8%). Seventeen patients with AO, IDH-mutant and 1p/19q-codeleted who underwent GTR experienced no recurrence. In conclusion, maximal surgical resection and postoperative radiotherapy resulted in a favorable prognosis, especially in patients with GTR, IDH mutation, and 1p/19q codeletion. Patterns of failure differed by EOR.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Schematic examples with the definitions of RT target volumes and patterns of recurrences. “infield GTV failure”: tumor recurrence or disease progression entirely within GTV; “infield CTV failure”: tumor recurrence within CTV; “marginal failure”: consisting of recurrent tumor crossing CTV; and “outfield failure”: in all other cases, referring to recurrences outside the RT field.
Figure 2
Figure 2
Progression-free survival and overall survival rates for all 73 patients.
Figure 3
Figure 3
(A) Overall survival rate according to the 2016 WHO classification (AO, anaplastic oligodendroglioma; AA, anaplastic astrocytoma; IDH, isocitrate dehydrogenase gene). (B) Overall survival rate by extent of resection (GTR, gross total resection; STR, subtotal resection; PR, partial resection; Bx, biopsy).
See this image and copyright information in PMC

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