Delev, Daniel ORCID: 0000-0001-9444-0178, Heiland, Dieter Henrik, Franco, Pamela, Reinacher, Peter ORCID: 0000-0003-1691-546X, Mader, Irina, Staszewski, Ori ORCID: 0000-0002-0579-6701, Lassmann, Silke, Grau, Stefan and Schnell, Oliver (2019). Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system. J. Neuro-Oncol., 141 (1). S. 223 - 234. NEW YORK: SPRINGER. ISSN 1573-7373

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Abstract

Purpose According to the 2016 WHO classification lower-grade gliomas consist of three groups: IDH-mutated and 1p/19q co-deleted, IDH-mutated and IDH-wildtype tumors. The aim of this study was to evaluate the impact of surgical therapy for lower-grade gliomas with a particular focus on the molecular subgroups. Methods This is a bi-centric retrospective analysis including 299 patients, who underwent treatment for lower-grade glioma between 1990 and 2016. All tumors were re-classified according to the 2016 WHO classification. Data concerning baseline and tumor characteristics, overall survival, different treatment modalities and functional outcome were analyzed. Results A total of 112 (37.5%) patients with IDH-mutation and 1p/19q co-deletetion, 86 (28.8%) patients with IDH-mutation and 101 (33.8%) patients with IDH-wildtype tumors were identified. The median overall survival (mOS) differed significantly between the groups (p < 0.001). Surgical resection was performed in 226 patients and showed significantly improved mOS compared to the biopsy group (p = 0.001). Gross total resection (GTR) was associated with better survival (p = 0.007) in the whole cohort as well as in the IDH-mutated and IDH-wildtype groups compared to partial resection or biopsy. IDH-wildtype patients presented a significant survival benefit after combined radio-chemotherapy compared to radio-or chemotherapy alone (p = 0.02). Good clinical status (NANO) was associated with longer OS (p = 0.001). Conclusion The impact of surgical treatment on the outcome of lower-grade gliomas depends to a great extent on the molecular subtype of the tumors. Patients with more aggressive tumors (IDH-wildtype) seem to profit from more intensive treatment like GTR, multiple resections and combined radio-/chemotherapy.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Delev, DanielUNSPECIFIEDorcid.org/0000-0001-9444-0178UNSPECIFIED
Heiland, Dieter HenrikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Franco, PamelaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reinacher, PeterUNSPECIFIEDorcid.org/0000-0003-1691-546XUNSPECIFIED
Mader, IrinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Staszewski, OriUNSPECIFIEDorcid.org/0000-0002-0579-6701UNSPECIFIED
Lassmann, SilkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grau, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schnell, OliverUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-139984
DOI: 10.1007/s11060-018-03030-w
Journal or Publication Title: J. Neuro-Oncol.
Volume: 141
Number: 1
Page Range: S. 223 - 234
Date: 2019
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1573-7373
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RESPONSE ASSESSMENT; VOLUMETRIC-ANALYSIS; SEIZURE FREEDOM; EANO GUIDELINE; IDH MUTATION; RESECTION; EXTENT; NEUROONCOLOGY; SURVIVAL; DIAGNOSISMultiple languages
Oncology; Clinical NeurologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13998

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