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Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system

Delev D, Heiland DH, Franco P, Reinacher P, Mader I, Staszewski O, Lassmann S, Grau S, Schnell O (2019)

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Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 141

Pages Range: 223-233

Journal Issue: 1

DOI: 10.1007/s11060-018-03030-w

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.

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How to cite

APA:

Delev, D., Heiland, D.H., Franco, P., Reinacher, P., Mader, I., Staszewski, O.,... Schnell, O. (2019). Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system. Journal of Neuro-Oncology, 141(1), 223-233. https://doi.org/10.1007/s11060-018-03030-w

MLA:

Delev, Daniel, et al. "Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system." Journal of Neuro-Oncology 141.1 (2019): 223-233.

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