Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas

Clinical article

Kaisorn L. Chaichana Departments of Neurosurgery,
Oncology, Johns Hopkins School of Medicine and the Kennedy-Krieger Institute, and the Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, Maryland

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 M.D.
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Matthew J. McGirt Departments of Neurosurgery,
Oncology, Johns Hopkins School of Medicine and the Kennedy-Krieger Institute, and the Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, Maryland

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 M.D.
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John Laterra Neurology, and
Oncology, Johns Hopkins School of Medicine and the Kennedy-Krieger Institute, and the Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, Maryland

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 M.D., Ph.D.
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Alessandro Olivi Departments of Neurosurgery,
Oncology, Johns Hopkins School of Medicine and the Kennedy-Krieger Institute, and the Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, Maryland

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 M.D.
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Alfredo Quiñones-Hinojosa Departments of Neurosurgery,
Oncology, Johns Hopkins School of Medicine and the Kennedy-Krieger Institute, and the Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Baltimore, Maryland

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Object

Unlike their malignant counterparts, low-grade gliomas are associated with prolonged survival. However, these tumors have a propensity to progress after resection and ultimately undergo malignant degeneration. The factors associated with recurrence and malignant degeneration remain relatively unknown. The authors set out to determine factors that were independently associated with recurrence and malignant degeneration in patients who underwent resection of a hemispheric low-grade glioma.

Methods

Adult patients who underwent craniotomy and resection of a hemispheric low-grade glioma (WHO Grade II) at the Johns Hopkins Medical Institution's academic tertiary-care institution between 1996 and 2006 were retrospectively reviewed. Multivariate proportional hazards regression analyses were used to identify associations with tumor recurrence and malignant degeneration.

Results

Of the 191 consecutive patients with low-grade gliomas in this series (89 fibrillary astrocytomas, 89 oligodendrogliomas, and 13 mixed gliomas), 83 (43%) and 44 (23%) experienced tumor recurrence and malignant degeneration at last follow-up, respectively. The 5-year progression-free and malignancy-free survival rates were 44 and 74%, respectively. Independent predictors of recurrence were duration of longest lasting symptom (relative risk [RR] 0.978, 95% CI 0.954–0.996, p = 0.01), tumor size (RR 1.328, 95% CI 1.109–1.602, p = 0.002), and preoperative contrast enhancement (RR 2.558, 95% CI 1.241–5.021, p = 0.01). Independent factors associated with malignant degeneration were fibrillary astrocytoma pathology (RR 1.800, 95% CI 1.008–4.928, p = 0.04), tumor size (RR 1.086, 95% CI 1.044–1.358, p = 0.04), and gross-total resection (RR 0.526, 95% CI 0.221–1.007, p = 0.05).

Conclusions

The identification and consideration of factors associated with recurrence and malignant progression may help guide treatment strategies aimed at delaying recurrence and preventing malignant degeneration for patients with hemispheric low-grade gliomas.

Abbreviations used in this paper:

FA = fibrillary astrocytoma; GTR = gross-total resection; IQR = interquartile range; KPS = Karnofsky Performance Scale; RR = relative risk; STR = subtotal resection.
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  • 1

    Berger MS, , Deliganis AV, , Dobbins J, & Keles GE: The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:17841791, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Byrne TN: Imaging of gliomas. Semin Oncol 21:162171, 1994

  • 3

    Chamberlain MC, , Murovic JA, & Levin VA: Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 38:13711374, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Chang EF, , Potts MB, , Keles GE, , Lamborn KR, , Chang SM, & Barbaro NM, et al.: Seizure characteristics and control following resection in 332 patients with low-grade gliomas. J Neurosurg 108:227235, 2008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Claus EB, , Horlacher A, , Hsu L, , Schwartz RB, , Dello-Iacono D, & Talos F, et al.: Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103:12271233, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Davis FS: Epidemiology of brain tumors. Expert Rev Anticancer Ther 7:S3S6, 2007

  • 7

    Donato V, , Papaleo A, , Castrichino A, , Banelli E, , Giangaspero F, & Salvati M, et al.: Prognostic implication of clinical and pathologic features in patients with glioblastoma multiforme treated with concomitant radiation plus temozolomide. Tumori 93:248256, 2007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Eyre HJ, , Crowley JJ, , Townsend JJ, , Eltringham JR, , Morantz RA, & Schulman SF, et al.: A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group study. J Neurosurg 78:909914, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Gannett DE, , Wisbeck WM, , Silbergeld DL, & Berger MS: The role of postoperative irradiation in the treatment of oligodendroglioma. Int J Radiat Oncol Biol Phys 30:567573, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Ginsberg LE, , Fuller GN, , Hashmi M, , Leeds NE, & Schomer DF: The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. Surg Neurol 49:436440, 1998

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Janny P, , Cure H, , Mohr M, , Heldt N, , Kwiatkowski F, & Lemaire JJ, et al.: Low grade supratentorial astrocytomas. Management and prognostic factors. Cancer 73:19371945, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Jeremic B, , Milicic B, , Grujicic D, , Samardzic M, , Antunovic V, & Dagovic A, et al.: Hyperfractionated radiation therapy for incompletely resected supratentorial low-grade glioma: a 10-year update of a phase II study. Int J Radiat Oncol Biol Phys 57:465471, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Keles GE, , Lamborn KR, & Berger MS: Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735745, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Kleihues P, , Louis DN, , Scheithauer BW, , Rorke LB, , Reifenberger G, & Burger PC, et al.: The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:215219, 2002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kreth FW, , Faist M, , Rossner R, , Volk B, & Ostertag CB: Supratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas. A new pattern of prognostic factors. Cancer 79:370379, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Kreth FW, , Faist M, , Warnke PC, , Rossner R, , Volk B, & Ostertag CB: Interstitial radiosurgery of low-grade gliomas. J Neurosurg 82:418429, 1995

  • 17

    Lamborn KR, , Chang SM, & Prados MD: Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro-oncol 6:227235, 2004

  • 18

    Laws ER Jr, , Taylor WF, , Clifton MB, & Okazaki H: Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61:665673, 1984

  • 19

    Leighton C, , Fisher B, , Bauman G, , Depiero S, , Stitt L, & Mac-Donald D, et al.: Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 15:12941301, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Lev MH, , Ozsunar Y, , Henson JW, , Rasheed AA, , Barest GD, & Harsh GR IV, et al.: Glial tumor grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: confounding effect of elevated rCBV of oligodendrogliomas [corrected]. AJNR Am J Neuroradiol 25:214221, 2004

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Lote K, , Egeland T, , Hager B, , Skullerud K, & Hirschberg H: Prognostic significance of CT contrast enhancement within histological subgroups of intracranial glioma. J Neurooncol 40:161170, 1998

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Lote K, , Egeland T, , Hager B, , Stenwig B, , Skullerud K, & Berg-Johnsen J, et al.: Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 15:31293140, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    McCormack BM, , Miller DC, , Budzilovich GN, , Voorhees GJ, & Ransohoff J: Treatment and survival of low-grade astrocytoma in adults–1977–1988. Neurosurgery 31:636642, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Medbery CA III, , Straus KL, , Steinberg SM, , Cotelingam JD, & Fisher WS: Low-grade astrocytomas: treatment results and prognostic variables. Int J Radiat Oncol Biol Phys 15:837841, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    North CA, , North RB, , Epstein JA, , Piantadosi S, & Wharam MD: Low-grade cerebral astrocytomas. Survival and quality of life after radiation therapy. Cancer 66:614, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Philippon JH, , Clemenceau SH, , Fauchon FH, & Foncin JF: Supratentorial low-grade astrocytomas in adults. Neurosurgery 32:554559, 1993

  • 27

    Piepmeier JM: Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres. J Neurosurg 67:177181, 1987

  • 28

    Piepmeier J, & Baehring JM: Surgical resection for patients with benign primary brain tumors and low grade gliomas. J Neurooncol 69:5565, 2004

  • 29

    Piepmeier J, , Christopher S, , Spencer D, , Byrne T, , Kim J, & Knisel JP, et al.: Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 38:872879, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Popko B, , Pearl DK, , Walker DM, , Comas TC, , Baerwald KD, & Burger PC, et al.: Molecular markers that identify human astrocytomas and oligodendrogliomas. J Neuropathol Exp Neurol 61:329338, 2002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Price SJ, , Jena R, , Burnet NG, , Carpenter TA, , Pickard JD, & Gillard JH: Predicting patterns of glioma recurrence using diffusion tensor imaging. Eur Radiol 17:16751684, 2007

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Schiff D, , Brown PD, & Giannini C: Outcome in adult low-grade glioma: the impact of prognostic factors and treatment. Neurology 69:13661373, 2007

  • 33

    Shaw E, , Arusell R, , Scheithauer B, , O'Fallon J, , O'Neill B, & Dinapoli R, et al.: Prospective randomized trial of low-versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 20:22672276, 2002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Shibamoto Y, , Kitakabu Y, , Takahashi M, , Yamashita J, , Oda Y, & Kikuchi H, et al.: Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables. Cancer 72:190195, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Smith JS, , Chang EF, , Lamborn KR, , Chang SM, , Prados MD, & Cha S, et al.: Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:13381345, 2008

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Stupp R, , Mason WP, , van den Bent MJ, , Weller M, , Fisher B, & Taphoorn MJ, et al.: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987996, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    van Veelen ML, , Avezaat CJ, , Kros JM, , van Putten W, & Vecht C: Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 64:581587, 1998

    • PubMed
    • Search Google Scholar
    • Export Citation

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