Final report from Intergroup NCCTG 86-72-51 (Alliance): a phase III randomized clinical trial of high-dose versus low-dose radiation for adult low-grade glioma

Neuro-Oncology - Tập 22 Số 6 - Trang 830-837 - 2020
William G. Breen1, S. Keith Anderson2, Xiomara W. Carrero2, Paul D. Brown1, Karla V. Ballman3, Brian Patrick O’Neill1, Walter J. Curran4, Ross A. Abrams5, Nadia N. Laack1, Ralph Levitt6, Evanthia Galanis1, Jan C. Buckner1, Edward G. Shaw7
1Mayo Clinic, Rochester, Minnesota
2Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
3Weill Medical College of Cornell University, New York, New York
4Emory University School of Medicine, Atlanta, Georgia
5Rush University Medical Center, Chicago, Illinois
6Fargo Clinic, North Fargo, North Dakota
7Wake Forest Baptist Health, Winston-Salem, North Carolina

Tóm tắt

AbstractBackgroundThe optimal radiation dose for adult supratentorial low-grade glioma is unknown. The aim of this study was to provide a final update on oncologic and cognitive outcomes of high-dose versus low-dose radiation for low-grade glioma.MethodsBetween 1986 and 1994, 203 patients with supratentorial low-grade glioma were randomized (1:1) to 50.4 Gy in 28 fractions versus 64.8 Gy in 36 fractions after any degree of resection.ResultsFor all patients, median overall survival (OS) was 8.4 years (95% CI: 7.2–10.8). Median progression-free survival (PFS) was 5.2 years (95% CI: 4.3–6.6). Median follow-up is 17.2 years for the 33 patients still alive. High-dose radiation did not improve 15-year OS (22.4%) versus low-dose radiation (24.9%, log-rank P = 0.978) or 15-year PFS (high dose, 15.2% vs low dose, 9.5%; P = 0.7142). OS was significantly better for patients with preoperative tumor diameter <5 cm and baseline Mini-Mental State Examination (MMSE) >27 and who underwent gross total resection. PFS was improved for patients with oligodendroglioma versus astrocytoma, preoperative tumor diameter <5 cm, patients who had gross total resection, and patients with baseline MMSE >27. For patients who had normal MMSE at baseline, at 7 years only 1 patient (5%) had a clinically significant decrease in MMSE from the previous time point, with the remainder (95%) stable. None had decrease in MMSE at 10, 12, or 15 years.ConclusionsLong-term follow-up indicates no benefit to high-dose over low-dose radiation for low-grade gliomas. Cognitive function appeared to be stable after radiation as measured by MMSE.

Từ khóa


Tài liệu tham khảo

Ostrom, 2018, CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011–2015, Neuro Oncol, 20, iv1, 10.1093/neuonc/noy131

Buckner, 2016, Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma, N Engl J Med., 374, 1344, 10.1056/NEJMoa1500925

Shaw, 1989, Radiation therapy in the management of low-grade supratentorial astrocytomas, J Neurosurg., 70, 853, 10.3171/jns.1989.70.6.0853

Karim, 1996, A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844, Int J Radiat Oncol Biol Phys., 36, 549, 10.1016/S0360-3016(96)00352-5

Shaw, 2002, Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study, J Clin Oncol., 20, 2267, 10.1200/JCO.2002.09.126

O’Brien, 1979, A multiple testing procedure for clinical trials, Biometrics, 35, 549, 10.2307/2530245

Wieand, 1994, Stopping when the experimental regimen does not appear to help, Stat Med., 13, 1453, 10.1002/sim.4780131321

Brown, 2003, Effects of radiotherapy on cognitive function in patients with low-grade glioma measured by the Folstein Mini-Mental State Examination, J Clin Oncol., 21, 2519, 10.1200/JCO.2003.04.172

Daniels, 2011, Validation of EORTC prognostic factors for adults with low-grade glioma: a report using intergroup 86-72-51, Int J Radiat Oncol Biol Phys., 81, 218, 10.1016/j.ijrobp.2010.05.003

Mantel, 1966, Evaluation of survival data and two new rank order statistics arising in its consideration, Cancer Chemother Rep., 50, 163

Central Nervous System Cancers, Version 1.2019., 2019

Pignatti, 2002, Prognostic factors for survival in adult patients with cerebral low-grade glioma, J Clin Oncol., 20, 2076, 10.1200/JCO.2002.08.121

Kiebert, 1998, Quality of life after radiation therapy of cerebral low-grade gliomas of the adult: results of a randomised phase III trial on dose response (EORTC trial 22844). EORTC Radiotherapy Co-operative Group, Eur J Cancer., 34, 1902, 10.1016/S0959-8049(98)00268-8

Baumert, 2016, Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study, Lancet Oncol., 17, 1521, 10.1016/S1470-2045(16)30313-8

Jaeckle, 2016, CODEL (Alliance-N0577; EORTC-26081/22086; NRG-1071, NCIC-CEC-2): phase III randomized study of RT vs. RT plus TMZ vs. TMZ for newly diagnosed 1p/19q-codeleted anaplastic oligodendroglial tumors. Analysis of patients treated on the original protocol design, Neurology, 86, 10.1212/WNL.86.16_supplement.PL02.005

Thông tin
Thông tin xuất bản

Neuro-Oncology

Tập 22 Số 6

830-837

Thông tin tác giả