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Surgical resection versus watchful waiting in low-grade gliomas.

Journal article
Authors Asgeir Store Jakola
A J Skjulsvik
K S Myrmel
K Sjåvik
G Unsgård
S H Torp
K Aaberg
T Berg
H Y Dai
K Johnsen
R Kloster
O Solheim
Published in Annals of oncology : official journal of the European Society for Medical Oncology
Volume 28
Issue 8
Pages 1942-1948
ISSN 1569-8041
Publication year 2017
Published at Institute of Neuroscience and Physiology
Pages 1942-1948
Language en
Links dx.doi.org/10.1093/annonc/mdx230
www.ncbi.nlm.nih.gov/entrez/query.f...
https://gup.ub.gu.se/file/207086
Subject categories Cancer and Oncology, Neurosurgery

Abstract

Background: Infiltrating low-grade gliomas (LGG; WHO grade 2) typically present with seizures in young adults. LGGs grow continuously and usually transform to higher grade of malignancy, eventually causing progressive disability and premature death. The effect of up-front surgery has been controversial and the impact of molecular biology on the effect of surgery is unknown. We now present long-term results of upfront surgical resection compared to watchful waiting in light of recently established molecular markers. Material and methods: Population-based parallel cohorts were followed from two Norwegian university hospitals with different surgical treatment strategies and defined geographical catchment regions. In region A watchful waiting was favored while early resection was favored in region B. Thus, the treatment strategy in individual patients depended on their residential address. The inclusion criteria were histopathological diagnosis of supratentorial LGG from 1998 through 2009 in patients 18 years or older. Follow-up ended 1st January 2016. Making regional comparisons, the primary end-point was overall survival. Results 153 patients (66 from region A, 87 from region B) were included. Early resection was carried out in 19 (29%) patients in region A compared to 75 (86%) patients in region B. Overall survival was 5.8 years (95% CI 4.5–7.2) in region A compared to 14.4 years (95% CI 10.4–18.5) in region B (P<0.01). The effect of surgical strategy remained after adjustment for molecular markers (P=0.001). Conclusion In parallel population based cohorts of LGGs, early surgical resection resulted in a clinical relevant survival benefit. The effect on survival persisted after adjustment for molecular markers.

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