Artikel
The role of surgery in patients with recurrent low-grade gliomas
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: The role of repeat surgery in the treatment of patients with low-grade gliomas (LGG) is not well defined. We therefore investigated the impact of reoperation in a large monoinstitutional cohort of patients with LGG at first recurrence (1R).
Method: For the present paper 154 consecutive patients were studied who underwent resection for a recurrent LGG in our institution between 1996 and 2011. Standard statistical methods were employed in order to analyze the demographics, clinical and treatment data of the study group.
Results: The cohort was 57.1% male. Median follow-up after first surgery (1S) and 1R were 97 and 36 months, respectively. Median age at 1R was 42 years. Median progression free survival after 1R (PFS2) was 51 months. 127 (82.4%) patients had surgery (with or without adjuvant therapy) at 1R, whereas 27 (17.6%) received radio or/and chemotherapy only. GTR were achieved in 24 (18.9%) cases undergoing an operation for 1R. 40 (31.4%) of the surgical patients were still diagnosed with a WHO grade II tumor (i.e. LGG). In 87 (68.6%) patients malignant progression was seen (WHO grade III: 69, WHO grade IV: 18). Peri- and postoperative complication rates were similar at 1S and 1R. Multivariate analysis identified surgery (resection vs. other therapy), histology at 1R (WHO grade IV vs. III vs. II) and chemotherapy (yes/no) as independent prognostic factors for PFS2. A subgroup analysis in patient with resections at 1R revealed a GTR as an independent prognostic factor for a longer PFS2.
Conclusions: Repeat operations for recurrent LGG (in particular GTR) were associated with prolonged progression free survival after first recurrence in our series but not with increased peri- and postoperative complication rates. These data suggest resective surgery (if safely possible) to be included in the primary treatment for recurrent LGG.