© Copyright 2008 by the Society for Neuro-Oncology
Received June 17, 2008
Accepted September 4, 2008
Intracranial Low-Grade Gliomas in Adults: 30-Year Experience With Long-term Follow-up at Mayo Clinic
David A. Schomas 1,
Nadia N. Laack 1*,
Ravi D. Rao 2,
Fredric B. Meyer 3,
Edward G. Shaw 4,
Brian Patrick O'Neill 5,
Caterina Giannini 6,
Paul D. Brown 1
1 Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
2 Department of Oncology, Mayo Clinic, Rochester, MN, USA
3 Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
4 Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC USA
5 Department of Neurology, Mayo Clinic, Rochester, MN, USA
6 Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
* To whom correspondence should be addressed. E-mail: laack.nadia{at}mayo.edu; scipubs@mayo.edu.
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Abstract |
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The purpose of this study was to evaluate long-term survival in patients with nonpilocytic low-grade gliomas (LGGs). Records of 314 adult patients with nonpilocytic LGGs diagnosed between 1960 and 1992 at Mayo Clinic, Rochester, Minnesota, were retrospectively reviewed. Kaplan-Meier method estimated progression-free survival (PFS) and overall survival (OS). Median age at diagnosis was 36 years. Median follow-up was 13.6 years. Operative pathology revealed pure astrocytoma in 181 patients (58%), oligoastrocytoma in 99 (31%), and oligodendroglioma in 34 (11%). Gross total resection was achieved in 41 patients (13%), radical subtotal resection (rSTR) in 33 (11%), subtotal resection in 130 (41%), and biopsy only in 110 (35%). Median OS was 6.9 years (range, 1 month-38.5 years). Adverse prognostic factors for OS identified by multivariate analysis were size of 5 cm or larger, pure astrocytoma histology, Kernohan grade 2, undergoing less than rSTR, and presentation with sensory motor symptoms. Statistically significant adverse prognostic factors for PFS by multivariate analysis were only size of 5 cm or larger and undergoing less than rSTR. In patients who underwent less than rSTR, RT was associated with improved OS and PFS. A substantial proportion of patients have a good long-term prognosis after GTR and rSTR, with nearly half of patients free of recurrence 15 years after diagnosis. Postoperative RT was associated with improved OS and PFS and is recommended for patients after subtotal resection or biopsy.
Key Words:
adult, combined modality, low-grade glioma, radiation, surgery
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