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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Infiltration of the subventricular zone in low-grade gliomas – molecular markers, management and outcome

Infiltration der subventrikulären Zone durch niedriggradige Gliome – molekulare Marker, Behandlung und Therapieergebnisse

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  • presenting/speaker Philipp Karschnia - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
  • Jonathan Weller - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
  • Jens Blobner - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
  • Veit M. Stoecklein - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
  • Louisa von Baumgarten - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurologie, München, Deutschland
  • Daniel B. Nasseh - Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Cancer Centre, München, Deutschland
  • Mario M. Dorostkar - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neuropathologie, München, Deutschland
  • Jorg Dietrich - Massachusetts General Hospital, Clinic of Neurology, Boston, MA, United States
  • Jörg-Christian Tonn - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
  • Niklas Thon - Klinikum der Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP175

doi: 10.3205/20dgnc459, urn:nbn:de:0183-20dgnc4599

Published: June 26, 2020

© 2020 Karschnia 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

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Objective: The subventricular zone (SVZ) represents the largest adult neural stem cell niche. Primary involvement of the SVZ is associated with decreased survival in high-grade glioma, however, clinical experience with low-grade glioma (LGG) is limited.

Methods: We retrospectively reviewed our institutional database of the Division of Neuro-Oncology for patients with LGG, WHO grade II°. We recorded imaging findings; histopathological as well as molecular information; therapeutic approaches; and outcome.

Results: 182 patients treated for LGG were identified, including 97 oligodendrogliomas and 85 astrocytomas. 78 of the 182 patients (43%) were found to have SVZ-involving LGG. Age, sex ratio, histopathology, MGMT promotor methylation status, and IDH mutation status did not differ between SVZ-involving LGG and non-SVZ-involving LGG. Symptoms were non-specific in both groups, and attributed to tumor mass effect. First-line therapeutic approaches included surgery, radiotherapy, chemotherapy, and wait-and-scan approaches, and did not differ between both groups. Mean follow-up time was 59 months.Overall, 43 patients (24%) showed malignant progression to high-grade glioma during follow-up. Involvement of the SVZ predicted shorter time to malignant progression (p= 0.002). Only in LGG involving the SVZ, there was a trend that therapy other than wait-and-scan might be associated with longer time to malignant progression (p= 0.078).Median overall survival was not reached after ten years. Twelve patients with SVZ-involving LGG had died at database closure, whereas only six patients with non-SVZ-involving LGG died (7% vs. 3%). SVZ involvement correlated negatively with overall survival (p= 0.023). MGMT promotor methylation (p= 0.001) and IDH mutation (p= 0.001) were positive prognostic markers for survival among LGG involving the subventricular zone.

Conclusion: SVZ involvement may convey a risk factor for malignant progression and outcome in LGG patients. Aggressive first-line therapy might be recommended in LGG involving the SVZ.MGMT promotor methylation status and IDH mutation status mayt be useful tools to further guide therapeutic approaches in such tumors.