Abstract
The goal of this work was to demonstrate prospectively that maximal surgical resection of low grade oligodendrogliomas without adjuvant therapy does not reduce life expectancy over that of historical controls. All patients with surgically accessible grade II oligodendrogliomas underwent maximal resection using stereotactic guidance and/or cortical mapping and were followed with serial MRI scans without adjuvant therapy until either progression or spread into brain regions deemed not surgically resectable. Nineteen patients were treated between 1993 and 2006. Ten patients required reoperation an average of 55 months after their first surgery. Nine patients progressed to anaplastic tumors an average of 42 months after their first surgery: six patients died from their tumors an average of 73 months after diagnosis, two are still alive 76 and 18 months after progression, and one was lost to follow up. Ten patients are alive and progression-free an average of 116 months after diagnosis, one of whom was lost to follow up at 106 months from diagnosis. Four patients are alive and event-free an average of 125 months after diagnosis. All are male and three had tumors in the superior frontal gyrus. The event-free survival, progression-free survival, and overall survival of our patients are not worse than those of patients treated with postoperative adjuvant therapy. Withholding adjuvant therapy at diagnosis appears to be safe. It will be important to establish the molecular differences between the patients who did very well and those who progressed so that adjuvant therapy could be offered to the latter.
Highlights
The management of low-grade oligodendrogliomas has been controversial, without a consensus in the neurooncological community on the role and timing of surgery [1,2] and of adjuvant radiation and chemotherapy [1,3,4,5,6,7]
In 1990, a prospective management protocol for low grade [WHO Grade II] oligodendrogliomas was begun which recommended radical resection followed by observation with serial MRI and the withholding of adjuvant therapy until demonstrated histopathological progression to a higher grade tumor or until the tumor spread into areas of the brain which contraindicated further resection
Our data show that half of our patients are alive and progression free an average of 116 months after diagnosis without adjuvant therapy, consistent with previous reports of the favorable natural history of many oligodendrogliomas
Summary
The management of low-grade oligodendrogliomas has been controversial, without a consensus in the neurooncological community on the role and timing of surgery [1,2] and of adjuvant radiation and chemotherapy [1,3,4,5,6,7]. For 19 years, the senior author [DAR] has prospectively managed low grade oligodendrogliomas amenable to surgery with radical resection using stereotactic guidance and intraoperative cortical mapping when indicated, followed by observation without adjuvant therapy until histological progression or extension into unresectable areas.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
