Article
Recurrent low-grade gliomas: hit hard after malignant transformation?
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Published: | June 9, 2017 |
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Objective: While numerous studies address the impact of extent of resection and different forms of adjuvant therapy in WHO grade II gliomas, the gap in knowledge concerning treatment options after malignant transformation is striking.
Methods: In a retrospective single-center study all adult patients with initial diagnosis of low-grade glioma between 1998 and 2015 undergoing tumor resection after malignant progression were identified. Besides demographic values, we evaluated preoperative Karnofsky performance score (KPS), histology, extent of resection and adjuvant treatment. Outcome measure was post-progression survival (PPS). For statistical calculation Kaplan–Meier estimates were used.
Results: A total of 43 patients with progressed LGG that had undergone surgery were identified. At the time of progression, the median age was 45 years and the median preoperative KPS 90%. In 25 patients (58.1%) complete resection of contrast enhancing tissue could be achieved. Median survival after re-resection was 57 months and median overall survival 137 months. Complete removal of contrast enhancing tumor tissue, adjuvant concomitant radio-chemotherapy, prior radiotherapy and oligodendroglial subtype were significantly correlated with improved PPS.
Conclusion: Patients in good clinical status with malignant transformation of previously treated low grade gliomas should receive aggressive treatment including re-resection followed by radio-chemotherapy.