Low-grade gliomas in adults
Tóm tắt
Adult patients with a magnetic resonance scan suggestive of a supratentorial low-grade glioma should generally undergo at least a stereotactic biopsy to confirm the diagnosis and rule out an anaplastic glioma or a non-neoplastic lesion. Early tumor treatment should be given to patients with newly diagnosed low-grade gliomas who are over age 50 years, those who have headaches or neurologic deficits other than seizures, or those whose neuroimaging studies show tumor growth or mass effect. For younger patients presenting with seizures and no other neurologic symptoms, it is reasonable to defer therapy until there is clinical or radiographic tumor progression. When it is judged that intervention is necessary, patients should undergo the maximal surgical tumor resection, which preserves or improves neurologic function. For younger (>50 years) astrocytoma patients with a good tumor resection, radiation may be deferred until tumor progression. Early radiation should be given to astrocytoma patients who are older than 50 years of age at diagnosis (regardless of the type of surgery) or to younger patients who are judged to require early intervention but who are not candidates for aggressive surgical resection. The radiation dose for low-grade glioma should be 4500 to 5000 cGy, preferably with three-dimensional conformal ports. The same guidelines for management apply to patients with low-grade oligodendroglioma or oligoastrocytoma, except that chemotherapy is a reasonable alternative to radiation when it is judged that treatment other than surgical resection is required.
Tài liệu tham khảo
Leighton C, Fisher B, Bauman G, et al.: Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 1997, 15:1294–1301.
Lote K, Egeland T, Hager B, et al.: Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 1997, 15:3129–3140.
van Veelen ML, Avezaat CJ, Kros JM, et al.: Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatr 1998, 64:581–587.
Olson JD, Riedel E, DeAngelis LM: Long-term outcome of low-grade oligodendroglioma and mixed glioma. Neurology 2000, 54:1442–1448. Single-institution review of 77 patients with oligodendroglioma and 29 patients with oligoastrocytoma.
Perry A: Pathology of low grade gliomas: an update of emerging concepts. Neuro-oncol 2003, 5:168–178. Review of the histology of low-grade gliomas and the impact of molecular genetics on tumor diagnosis and classification.
Azzarelli B, Miravalle L, Vidal R: Immunolocalization of the oligodendrocyte transcription factor 1 (Olig1) in brain tumors. J Neuropathol Exp Neurol 2004, 63:170–179.
Fisher BJ, Naumova E, Leighton CC, et al.: Ki-67: a prognostic factor for low-grade glioma? Int J Rad Oncol Biol Phys 2002, 52:996–1001.
Hirose Y, Aldape KD, Chang S, et al.: Grade II astrocytomas are subgrouped by chromosome aberrations. Cancer Gener Cytogenet 2003, 142:1–7.
Wessels PH, Hopman AH, Kubat B, et al.: Proliferation and aneusomy predict survival of young patients with astrocytoma grade 2. Brit J Cancer 2003, 89:128–134.
Sasaki H, Zlatescu MC, Betensky RA, et al.: Histopathological-molecular genetic correlations in referral pathologist-diagnosed low-grade “oligodendroglioma”. J Neuropathol Exp Neurol 2002, 61:58–63.
Reifenberger G, Louis DN: Oligodendroglioma: toward molecular definitions in diagnostic neuro-oncology. J Neuropathol Exp Neurol 2003, 62:111–126. Comprehensive summary of the molecular genetics of oligodendroglioma and oligoastrocytoma, and the potential implications for patient management.
van den Bent MJ, Looijenga LH, Langenberg K, et al.: Chromosomal anomalies in oligodendroglial tumors are correlated with clinical features. Cancer 2003, 97:1276–1284.
Mueller W, Hartmann C, Hoffmann A, et al.: Genetic signature of oligoastrocytomas correlates with tumor location and denotes distinct molecular subsets. Am J Pathol 2002, 161:313–319.
Pignatti F, van den Bent M, Curran D, et al.: Prognostic factors for survival in adult patients with cerebral lowgrade glioma. J Clin Oncol 2002, 20:2076–2084. Analysis of more than 600 patients entered into two European Organization for Research and Treatment of Cancer randomized radiotherapy trials (references [20] and [21]). Multivariate analysis showed patient age and tumor histology to be the strongest independent predictors of survival.
Shaw E, Arusell R, Scheithauer B, et al.: Prospective randomized trial of low-dose versus high-dose radiation therapy in adults with supratentorial lowgrade glioma. J Clin Oncol 2002, 20:2267–2276. There was no difference in median time to tumor progression or in median overall survival between patients receiving 6480 cGy versus 5040 cGy.
Bauman G, Lote K, Larson D, et al.: Pretreatment factors predict overall survival for patients with lowgrade glioma: a recursive partitioning analysis. Int J Rad Oncol Biol Phys 1999, 45:923–929.
Berger MS, Rostomily RC: Low grade gliomas: functional mapping resection strategies, extent of resection, and outcome. J Neurooncol 1997, 34:85–101.
Keles GE, Lamborn KR, Berger MS: Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 2001, 95:735–745. Detailed review and analysis of the data (all retrospective) supporting or refuting the survival impact of aggressive “cytoreductive” surgery.
Lo SS, Cho KH, Hall WA, et al.: Does the extent of surgery have an impact on the survival of patients who receive postoperative radiation therapy for supratentorial lowgrade gliomas? Int J Cancer 2001, 96(bdsuppl):71–78.
Karim AB, Maat B, Hatlevoll R, et al.: A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer study 22844. Int J Rad Oncol Biol Phys 1996, 36:549–556.
Karim AB, Afra D, Cornu P, et al.: Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult. Int J Rad Oncol Biol Phys 2002, 52:316–324. Patients randomized to receive 5400 cGy radiotherapy immediately after initial tumor biopsy or resection did not have a longer survival than patients in whom radiation was deferred until tumor progression. Interim analysis indicated a positive effect of early radiation on time to tumor progression.
Armstrong CL, Hunter JV, Ledakis GE, et al.: Late cognitive and radiographic changes related to radiotherapy: initial prospective findings. Neurology 2002, 59:40–48.
Postma TJ, Klein M, Verstappen CC, et al.: Radiotherapyinduced cerebral abnormalities in patients with lowgrade glioma. Neurology 2002, 59:121–123.
Surma-aho O, Niemela M, Vilkki J, et al.: Adverse longterm effects of brain radiotherapy in adult low-grade glioma patients. Neurology 2001, 56:1285–1290.
Klein M, Heimans JJ, Aaronson NK, et al.: Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in lowgrade gliomas: a comparative study. Lancet 2002, 360:1361–1368. Retrospective review of 195 patients from the Netherlands examining the contributions of tumor, radiotherapy, epilepsy, and antiepileptic drugs on patients’ long-term neurocognitive functioning.
Torres IJ, Mundt AJ, Sweeney PJ, et al.: A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors. Neurology 2003, 60:1113–1118.
Buckner JC, Gesme D, O’Fallon JR, et al.: Phase II trial of procarbazine, lomustine, and vincristine as initial therapy for patients with low-grade oligodendroglioma or oligoastrocytoma: efficacy and associations with chromosomal abnormalities. J Clin Oncol 2003, 21:251–255. Thirteen of 25 patients (52%) showed a radiographic response to dose-intensified PCV chemotherapy given before radiotherapy.
Quinn JA, Reardon DA, Friedman AH, et al.: Phase II trial of temozolomide in patients with progressive low-grade glioma. J Clin Oncol 2003, 21:646–651.
van den Bent MJ, Taphoorn MJ, Brandes AA, et al.: Phase II study of first-line chemotherapy with temozolomide in recurrent oligodendroglial tumors: The EORTC brain tumor group study 26971. J Clin Oncol 2003, 21:2525–2528.
Klein M, Engelberts NH, van der Ploeg HM, et al.: Epilepsy in low-grade gliomas: the impact on cognitive function and quality of life. Ann Neurol 2003, 54:514–520. More than one third of patients in this retrospective review from the Netherlands continued to have seizures despite antiepileptic drug monotherapy or polytherapy.