gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Clinical and molecular factors impacting progression and survival in IDH1 mutant glioma patients

Meeting Abstract

  • Franziska Löbel - Charité - Universitätsmedizin Berlin, Campus Mitte, Klinik für Neurochirurgie, Berlin, Deutschland
  • Tareq A. Juratli - Department of Neurosurgery, Charité University Medical Center, Berlin, Germany,; Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Boston, United States
  • Ganesh M. Shankar - Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Boston, United States
  • Daniel A. Mordes - Harvard Medical School, Massachusetts General Hospital Cancer Center, Department of Pathology, Boston, United States
  • Nina Lelic - Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Boston, United States
  • Tracy T. Batchelor - Harvard Medical School, Massachusetts General Hospital, Translational Neuro-Oncology Laboratory, Boston, United States
  • A. John Iafrate - Harvard Medical School, Massachusetts General Hospital Cancer Center, Department of Pathology, Translational Neuro-Oncology Laboratory, Boston, United States
  • Fred G. Barker II - Harvard Medical School, Massachusetts General Hospital, Department of Neurosurgery, Boston, United States
  • Andrew S. Chi - NYU Langone Medical Center, Department of Neuro-Oncology, New York City, United States
  • Daniel P. Cahill - Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Translational Neuro-Oncology Laboratory, Boston, United States

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.14.03

doi: 10.3205/17dgnc456, urn:nbn:de:0183-17dgnc4565

Published: June 9, 2017

© 2017 Löbel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: Isocitrate dehydrogenase 1 (IDH1) mutant tumors represent a distinct subtype among diffuse gliomas, with improved prognosis compared to histological grade-matched IDH1 wild-type tumors. Here, we sought to identify factors associated with outcome exclusively within the glioma subgroup defined by IDH1 mutation.

Methods: We retrospectively analyzed 214 IDH1 mutant glioma patients (112 WHO grade II, 76 grade III, 26 grade IV) treated at our institution to determine clinical and molecular factors associated with time-to-treatment-failure (TTF) and overall survival (OS). TERT promotor mutation analysis was performed to identify molecular subgroups in our population.

Results: At median follow-up in survivors of 8.38 years, 58 deaths (27.1%) were recorded in the cohort. Median TTF was 5.0 years (95% CI 4.6-5.8) and median OS was 14.6 years (95% CI 12.1–17.4). Adjuvant radiation (median 6.2 versus 4.5 years, p=.019) and more-extensive resection (MER) (median 6.7 versus 4.5 years, p<.001) were associated with prolonged TTF. Both remained significant predictive factors in a multivariate model of TTF including age and histological grade (HR=.395 for radiation, p=.0011 and HR=.520 for MER, p=.0062). MER was also significantly associated with prolonged OS (median 19.01 versus 13.23 years, p=.0119). In the TERT wild-type subgroup, both TTF (median 7.8 versus 3.8 years; p <.0001) and OS (median 19.0 versus 11.5 years; p=.0133) were significantly prolonged in patients that received a MER. Additionally, adjuvant radiation (median 6.2 versus 3.8 years; p=.0019) and adjuvant chemotherapy (median 6.2 versus 3.8 years; p=.0025) significantly improved TTF, but not OS. Interestingly, in the TERT mutated subgroup we did not observe a significant benefit from MER (p=.534), adjuvant radiation (p=.08) or chemotherapy (p=.88) for TTF.

Conclusion: Within IDH1 mutant gliomas, adjuvant radiation therapy and more-extensive resection are independently associated with improved TTF and OS. TERT wild-type patients seem to benefit from MER and adjuvant radiation or chemotherapy.