P08.34 Overall survival of primary high-grade gliomas of supra- and infratentorial midline structures

Abstract

AbstractObjective:In literature recent and roubust data on the prognosis of patients with high grade gliomas (HGG) of WHO III° and IV° stratified by resectability, molecular features and different treatment modalities are available. However, little is known about outcome of patients with HGG´s located in supra- and infratentorial midline structures like corpus callosum, basal ganglia and brainstem. In this study we evaluate overall survival (OS) and influencing factors of patients with de novo HGG specifically in those structures.Patients and Methods:In a single center retrospective analysis we screened our database for all adult patients with primary HGG in midline structures diagnosed by stereotactic biopsy (SB) between January 1996 and March 2015. We evaluated OS and analyzed factors (MGMT status, treatment after SB, age, gender, Karnofsky Score (KPS), localization) influencing OS using Whitney-Mann-U and Chi-square test as well as cox regression analysis.Results.122 patients with HGG receiving stereotactic biopsy procedures (median age: 56.3 (22–82) years; median KPS: 80 (50–100)%. Histology revealed glioma WHO III° in 31.1% and WHO IV° in 68.9%. Lesions were localized in corpus callosum (50.0%), basal ganglia (18.9%), thalamus (9.0%), pineal region (2.5%), sella (0.8%), brainstem (18.9%). Median overall survival (mOS) was 6.3 months (95% CI, 3.6–9.0%), for WHO III°: 13.6 months (95% CI 5.6–21.6) and WHO IV°: 4.9 months (95 % CI, 3.2–6.6). Patients were treated as follows: no specific tumor therapy (13.1%, 2 WHO III° and 15 WHO IV°; mOS 1.1 months) or various Tumor specific therapy regimens (WHO III° 34 (32.4%) patients mOS 15.5 month [95% CI 7.4–23.6]), (WHO IV° 65 (61.9%) patients mOS 10.6 months). In 6 patients (5.7%) the type of adjuvant therapy is unknown. MGMT promotor methylation status was available for 46 tumor treated patients (18 WHO III°, 28 WHO IV°). mOS of patients with WHO IV tumors was significantly worse than WHO III° (p<0.0001). Any tumor specific treatment improved survival significantly (p=0.005). Poor condition (KPS<70) and no tumor specific therapy were the significant factors for poor OS in multivariate analysis (adjusted HR 1.88 CI95% 1.03–3.92 p=0.04 and 11.09 CI95% 5.24–23.35 p<0.0001 respectively).Conclusion:Overall survival de novo HGG’s especially of WHO IV located in midline structures is poor. Specific tumor treatment improves survival significantly. Treatment decision should be based on the patient’s clinical status for the best quality of life.