Prognostic factors and outcomes in anaplastic gliomas: An institutional experience

Deepthi Valiyaveettil; Monica Malik; Deepa Joseph; Syed Fayaz Ahmed; Syed Akram Kothwal

doi:10.4103/sajc.sajc_55_17

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ORIGINAL ARTICLE: Brain Tumors

07 (

); 01-04

doi:

10.4103/sajc.sajc_55_17

Prognostic factors and outcomes in anaplastic gliomas: An institutional experience

Deepthi Valiyaveettil¹, Monica Malik^1,, Deepa Joseph¹, Syed Fayaz Ahmed¹, Syed Akram Kothwal¹

1 Department of Radiation Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India

*Corresponding author: Dr. Monica Malik. dr_monica11@yahoo.com

Published: 2020-12-22

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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Abstract

Background: There is lack of clear evidence and treatment guidelines for anaplastic gliomas (AGs) with very few studies focusing exclusively on these patients. The aim of the study was to analyze the clinical profile and survival in these patients. Materials and Methods: Patients of AGs treated with radiation and concurrent ± adjuvant chemotherapy from January 2010 to December 2015 were analyzed. Statistical analysis was done using SPSS version 20 software. Results: A total of 100 patients were included in the study. The median age was 35 years (range 6–68 years). Eighty-four patients had follow-up details and were included for survival analysis. The 5-year overall survival (OS) was 58%. Age, presentation with seizures, and focal neurological deficit were not found to significantly influence survival. The 5-year survival for oligodendroglioma and astrocytoma was 69% and 52%, respectively. Patients with Karnofsky Performance Score (KPS) of ≥70 had a significantly better 5-year OS (65%) as compared to those with KPS <70 (33%) (P = 0.000). The use of adjuvant temozolomide (TMZ) showed longer 5-year OS of 67.7% compared to 36% in patients who did not receive adjuvant chemotherapy (P = 0.018). Patients receiving both concurrent and adjuvant TMZ showed longer 5-year OS (68.5% vs. 40%, P = 0.010). Twenty-two patients had recurrence with average time to recurrence being 37 months. Fourteen patients underwent salvage surgery and two patients received reirradiation. Conclusions: OS significantly correlated with KPS and receipt of concurrent and adjuvant chemotherapy with TMZ. Therefore, adjuvant radiation with concurrent and adjuvant TMZ should be the standard of care for AGs.

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References

Ricard D, Idbaih A, Ducray F, Lahutte M, Hoang-Xuan K, Delattre JY, et al. Primary brain tumours in adults. Lancet 2012;379:1984-96.
Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, et al. Survival following surgery and prognostic factors for recently diagnosed malignant glioma: Data from the Glioma Outcomes Project. J Neurosurg 2003;99:467-73.
Walker MD, Alexander E Jr., Hunt WE, MacCarty CS, Mahaley MS Jr., Mealey J Jr., et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 1978;49:333-43.
Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: A prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 1981;47:649-52.
Abrey LE, Louis DN, Paleologos N, Lassman AB, Raizer JJ, Mason W, et al. Survey of treatment recommendations for anaplastic oligodendroglioma. Neuro Oncol 2007;9:314-8.
Dasgupta A, Gupta T, Jalali R. Indian data on central nervous tumors: A summary of published work. South Asian J Cancer 2016;5:147-53.
DeAngelis LM. Anaplastic glioma: How to prognosticate outcome and choose a treatment strategy. [corrected]. J Clin Oncol 2009;27:5861-2.
Brandes AA, Nicolardi L, Tosoni A, Gardiman M, Iuzzolino P, Ghimenton C, et al. Survival following adjuvant PCV or temozolomide for anaplastic astrocytoma. Neuro Oncol 2006;8:253-60.
Stupp R, Reni M, Gatta G, Mazza E, Vecht C. Anaplastic astrocytoma in adults. Crit Rev Oncol Hematol 2007;63:72-80.
See SJ, Gilbert MR. Anaplastic astrocytoma: Diagnosis, prognosis, and management. Semin Oncol 2004;31:618-34.
Prados MD, Gutin PH, Phillips TL, Wara WM, Larson DA, Sneed PK, et al. Highly anaplastic astrocytoma: A review of 357 patients treated between 1977 and 1989. Int J Radiat Oncol Biol Phys 1992;23:3-8.
Gan HK, Rosenthal MA, Dowling A, Kalnins R, Algar E, Wong N, et al. Aphase II trial of primary temozolomide in patients with grade III oligodendroglial brain tumors. Neuro Oncol 2010;12:500-7.
Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: Long-term results of RTOG 9402. J Clin Oncol 2013;31:337-43.
Parkinson JF, Afaghi V, Payne CA, Buckland ME, Brewer JM, Biggs MT, et al. The impact of molecular and clinical factors on patient outcome in oligodendroglioma from 20 years' experience at a single centre. J Clin Neurosci 2011;18:329-33.
Miller CR, Dunham CP, Scheithauer BW, Perry A. Significance of necrosis in grading of oligodendroglial neoplasms: A clinicopathologic and genetic study of newly diagnosed high-grade gliomas. J Clin Oncol 2006;24:5419-26.
Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10:459-66.
van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: Long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 2013;31:344-50.
Yung WK, Prados MD, Yaya-Tur R, Rosenfeld SS, Brada M, Friedman HS, et al. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol 1999;17:2762-71.
Smrdel U, Kovac V, Popovic M, Zwitter M. Glioblastoma patients in slovenia from 1997 to 2008. Radiol Oncol 2014;48:72-9.
Kim YH, Park CK, Cho WH, Kim IA, Moon S, Choe G, et al. Temozolomide during and after radiation therapy for WHO grade III gliomas: Preliminary report of a prospective multicenter study. J Neurooncol 2011;103:503-12.
Kizilbash SH, Giannini C, Voss JS, Decker PA, Jenkins RB, Hardie J, et al. The impact of concurrent temozolomide with adjuvant radiation and IDH mutation status among patients with anaplastic astrocytoma. J Neurooncol 2014;120:85-93.
Weller M, van den Bent M, Hopkins K, Tonn JC, Stupp R, Falini A, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014;15:e395-403.
van den Bent MJ, Erridge S, Vogelbaum M, Nowak A, Sanson M, Brandes AA, et al. EH1.1 results of the interim analysis of the EORTC randomized phase III CATNON trial on concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q co-deletion, an intergroup trial. Neuro Oncol 2016;18 Suppl 4:iv1.

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[1] Ricard D, Idbaih A, Ducray F, Lahutte M, Hoang-Xuan K, Delattre JY, et al. Primary brain tumours in adults. Lancet 2012;379:1984-96.

[2] Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, et al. Survival following surgery and prognostic factors for recently diagnosed malignant glioma: Data from the Glioma Outcomes Project. J Neurosurg 2003;99:467-73.

[3] Walker MD, Alexander E Jr., Hunt WE, MacCarty CS, Mahaley MS Jr., Mealey J Jr., et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 1978;49:333-43.

[4] Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: A prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 1981;47:649-52.

[5] Abrey LE, Louis DN, Paleologos N, Lassman AB, Raizer JJ, Mason W, et al. Survey of treatment recommendations for anaplastic oligodendroglioma. Neuro Oncol 2007;9:314-8.

[6] Dasgupta A, Gupta T, Jalali R. Indian data on central nervous tumors: A summary of published work. South Asian J Cancer 2016;5:147-53.

[7] DeAngelis LM. Anaplastic glioma: How to prognosticate outcome and choose a treatment strategy. [corrected]. J Clin Oncol 2009;27:5861-2.

[8] Brandes AA, Nicolardi L, Tosoni A, Gardiman M, Iuzzolino P, Ghimenton C, et al. Survival following adjuvant PCV or temozolomide for anaplastic astrocytoma. Neuro Oncol 2006;8:253-60.

[9] Stupp R, Reni M, Gatta G, Mazza E, Vecht C. Anaplastic astrocytoma in adults. Crit Rev Oncol Hematol 2007;63:72-80.

[10] See SJ, Gilbert MR. Anaplastic astrocytoma: Diagnosis, prognosis, and management. Semin Oncol 2004;31:618-34.

[11] Prados MD, Gutin PH, Phillips TL, Wara WM, Larson DA, Sneed PK, et al. Highly anaplastic astrocytoma: A review of 357 patients treated between 1977 and 1989. Int J Radiat Oncol Biol Phys 1992;23:3-8.

[12] Gan HK, Rosenthal MA, Dowling A, Kalnins R, Algar E, Wong N, et al. Aphase II trial of primary temozolomide in patients with grade III oligodendroglial brain tumors. Neuro Oncol 2010;12:500-7.

[13] Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: Long-term results of RTOG 9402. J Clin Oncol 2013;31:337-43.

[14] Parkinson JF, Afaghi V, Payne CA, Buckland ME, Brewer JM, Biggs MT, et al. The impact of molecular and clinical factors on patient outcome in oligodendroglioma from 20 years' experience at a single centre. J Clin Neurosci 2011;18:329-33.

[15] Miller CR, Dunham CP, Scheithauer BW, Perry A. Significance of necrosis in grading of oligodendroglial neoplasms: A clinicopathologic and genetic study of newly diagnosed high-grade gliomas. J Clin Oncol 2006;24:5419-26.

[16] Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10:459-66.

[17] van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: Long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 2013;31:344-50.

[18] Yung WK, Prados MD, Yaya-Tur R, Rosenfeld SS, Brada M, Friedman HS, et al. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol 1999;17:2762-71.

[19] Smrdel U, Kovac V, Popovic M, Zwitter M. Glioblastoma patients in slovenia from 1997 to 2008. Radiol Oncol 2014;48:72-9.

[20] Kim YH, Park CK, Cho WH, Kim IA, Moon S, Choe G, et al. Temozolomide during and after radiation therapy for WHO grade III gliomas: Preliminary report of a prospective multicenter study. J Neurooncol 2011;103:503-12.

[21] Kizilbash SH, Giannini C, Voss JS, Decker PA, Jenkins RB, Hardie J, et al. The impact of concurrent temozolomide with adjuvant radiation and IDH mutation status among patients with anaplastic astrocytoma. J Neurooncol 2014;120:85-93.

[22] Weller M, van den Bent M, Hopkins K, Tonn JC, Stupp R, Falini A, et al. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014;15:e395-403.

[23] van den Bent MJ, Erridge S, Vogelbaum M, Nowak A, Sanson M, Brandes AA, et al. EH1.1 results of the interim analysis of the EORTC randomized phase III CATNON trial on concurrent and adjuvant temozolomide in anaplastic glioma without 1p/19q co-deletion, an intergroup trial. Neuro Oncol 2016;18 Suppl 4:iv1.

Prognostic factors and outcomes in anaplastic gliomas: An institutional experience

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Abstract

Keywords

References

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