Observation versus radiotherapy with or without temozolomide in postoperative WHO grade II high-risk low-grade glioma: a retrospective cohort study.

Abstract

The optimal adjuvant treatment of high-risk low-grade glioma (LGG) is controversial. We performed this retrospective cohort study to compare three treatments including observation, radiotherapy (RT) alone, and radiotherapy combined with concomitant and adjuvant temozolomide (TMZ) chemotherapy (STUPP regimen) in patients with high-risk LGG. Patients with high-risk (age > 40 or undergoing subtotal resection or biopsy) LGG treated with observation or radiotherapy alone or STUPP regimen after operation were retrospectively analyzed. Survival rates were evaluated by the Kaplan-Meier method; the log-rank test was applied to compare differences between groups. A total of 250 patients met the inclusion criteria. Median follow-up for living people was 70 months. Overall, patients who received radiotherapy with or without temozolomide had better progression-free survival (PFS) and overall survival (OS) when compared with observation (median PFS: observation, 59 months; RT, 82 months; STUPP, not reached; median OS: observation, 96 months; RT, not reached; STUPP, not reached), whereas STUPP regimen did not further prolong PFS or OS than RT alone (PFS, P = 0.203; OS, P = 0.146). In oligodendroglioma (IDH mutant and 1p/19q codeleted) subtype, only STUPP regimen brought longer PFS when compared with observation (P = 0.008). The incidence of grade 3 or 4 neutropenia (P < 0.001) and nausea or vomiting (P = 0.004) was higher in the STUPP group than the figure for the RT alone group. PFS and OS were similarly improved in patients with high-risk LGG receiving RT alone or STUPP regimen. However, only STUPP regimen was able to bring better PFS for oligodendroglioma (IDH mutant and 1p/19q codeleted) subgroup. Longer follow-up time is needed to determine an association with treatment effect in different histological and molecular subgroups.

• Authors: Jingjing Wang, Lvjun Yan, Ping Ai, Yan He, Hui Guan, Zhigong Wei, Ling He, Xiaoli Mu, Yanhui Liu, Xingchen Peng
• Journal: Neurosurgical review (Neurosurg Rev) Vol. 44 Issue 3 Pg. 1447-1455 (Jun 2021) ISSN: 1437-2320 [Electronic] Germany
• PMID: 32529528 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antineoplastic Agents, Alkylating
• Temozolomide

Topics

• Adult
• Aged
• Antineoplastic Agents, Alkylating (therapeutic use)
• Brain Neoplasms (diagnostic imaging, drug therapy, radiotherapy)
• Cohort Studies
• Female
• Follow-Up Studies
• Glioma (diagnostic imaging, drug therapy, radiotherapy)
• Humans
• Male
• Middle Aged
• Neoplasm Grading (methods)
• Postoperative Care (trends)
• Progression-Free Survival
• Retrospective Studies
• Survival Rate (trends)
• Temozolomide (therapeutic use)
• Watchful Waiting (trends)
• World Health Organization