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First published on November 18, 2008
This version was published on January 1, 2009
Neuro Oncol 2009 11(4):437-445; DOI:10.1215/15228517-2008-102
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Duke University Press

Clinical Investigations

Intracranial low-grade gliomas in adults: 30-year experience with long-term follow-up at Mayo Clinic

David A. Schomas, Nadia N. Issa Laack, Ravi D. Rao, Fredric B. Meyer, Edward G. Shaw, Brian Patrick O'Neill, Caterina Giannini and Paul D. Brown

Departments of Radiation Oncology (D.A.S., N.N.L., P.D.B.), Oncology (R.D.R.), Neurologic Surgery (F.B.M.), Neurology (B.P.O.), and Division of Anatomic Pathology (C.G.), Mayo Clinic, Rochester, MN; Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (E.G.S.); USA

Address correspondence to Nadia N. Laack, Department of Radiation Oncology, Mayo Clinic, 200 First St., SW, Rochester, MN 55905, USA (laack.nadia{at}mayo.edu).

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 the Mayo Clinic, Rochester, Minnesota, were retrospectively reviewed. The 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 (GTR) 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 tumor size 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 tumor size 5 cm or larger and undergoing less than rSTR. In patients who underwent less than rSTR, radiotherapy (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 10 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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