Reflecting on survivorship outcomes to aid initial decision making in patients treated for IDH-mutated anaplastic glioma.

Abstract

Patients with anaplastic glioma (AG) harboring an isocitrate dehydrogenase mutation have potential durable survival after intensity-modulated radiotherapy (IMRT) and chemotherapy. Understanding long-term functioning, and the factors that have an impact on later effects, is important for decision making. Consecutive patients with AG who received IMRT were reviewed with regard to 6 survivorship domains, including Eastern Cooperative Oncology Group (ECOG) performance status, Medical Research Council (MRC) neurological status, late toxicity, comorbidity, functional status (employment/driving), and psychosocial events. Assessments were performed at baseline before RT; at month +6; and at years +1, +3, and +5 after RT. The primary endpoints were ECOG at year +3 and employment at year +3. A total of 146 patients were included, with a median follow-up of 5.1years. The 6-year overall survival rate was 78.7% (95% CI, 71.1%-87.0%). Baseline ECOG performance status was 0 to 1 in 82.2% of patients but improved at year +1 (95.7%) and year +3 (97.2%). Employment rates at year +3 and year +5 were 70.1% and 76.5%, respectively, compared with 61.6% at baseline. Worse ECOG performance status at year +3 was related to the anaplastic astrocytoma subtype (P=.001), delayed RT (P=.081), multiple craniotomies performed before RT (P=.002), worse ECOG performance status before RT (P<.001), worse MRC neurological status before RT (P<.001), seizures (P=.038), neurocognitive disturbance (P<.001), and the presence of recurrent disease (P=.004). Absent or impaired employment at year +3 was found to be related to older age (P=.007), delayed timing of RT (P=.023), multiple craniotomies prior to RT (P=.005), worse ECOG performance status before RT (P<.001), worse MRC neurological status before RT (P<.001), and neurocognitive disturbance (P<.001). Patients with AG with an isocitrate dehydrogenase mutation have the potential for prolonged survival. Functional status appears to be good in patients who are free of disease progression at 3 to 5years after IMRT, with >95% of patients having high ECOG performance status and >75% being employed.