TY  - JOUR
A1  - Steidl, Eike
A1  - Filipski, Katharina Johanna
A1  - Zeiner, Pia Susan
A1  - Wagner, Marlies
A1  - Fokas, Emmanouil
A1  - Forster, Marie-Thérèse
A1  - Ronellenfitsch, Michael Wilfried
A1  - Divé, Iris
A1  - Steinbach, Joachim Peter
A1  - Harter, Patrick Nikolaus
A1  - Bähr, Roy Oliver
T1  - A 25-year retrospective, single center analysis of 343 WHO grade II/III glioma patients: implications for grading and temozolomide therapy
T2  - Journal of cancer research and clinical oncology
N2  - Purpose: Classification and treatment of WHO grade II/III gliomas have dramatically changed. Implementing molecular markers into the WHO classification raised discussions about the significance of grading and clinical trials showed overall survival (OS) benefits for combined radiochemotherapy. As molecularly stratified treatment data outside clinical trials are scarce, we conducted this retrospective study.
Methods: We identified 343 patients (1995–2015) with newly diagnosed WHO grade II/III gliomas and analyzed molecular markers, patient characteristics, symptoms, histology, treatment, time to treatment failure (TTF) and OS.
Results: IDH-status was available for all patients (259 mutant, 84 IDH1-R132H-non-mutant). Molecular subclassification was possible in 173 tumors, resulting in diagnosis of 80 astrocytomas and 93 oligodendrogliomas. WHO grading remained significant for OS in astrocytomas/IDH1-R132H-non-mutant gliomas (p < 0.01) but not for oligodendroglioma (p = 0.27). Chemotherapy (and temozolomide in particular) showed inferior OS compared to radiotherapy in astrocytomas (median 6.1/12.1 years; p = 0.03) and oligodendrogliomas (median 13.2/not reached (n.r.) years; p = 0.03). While radiochemotherapy improved TTF in oligodendroglioma (median radiochemotherapy n.r./chemotherapy 3.8/radiotherapy 7.3 years; p < 0.001/ = 0.06; OS data immature) the effect, mainly in combination with temozolomide, was weaker in astrocytomas (median radiochemotherapy 6.7/chemotherapy 2.3/radiotherapy 2.0 years; p < 0.001/ = 0.11) and did not translate to improved OS (median 8.4 years).
Conclusion: This is one of the largest retrospective, real-life datasets reporting treatment and outcome in low-grade gliomas incorporating molecular markers. Current histologic grading features remain prognostic in astrocytomas while being insignificant in oligodendroglioma with interfering treatment effects. Chemotherapy (temozolomide) was less effective than radiotherapy in both astrocytomas and oligodendrogliomas while radiochemotherapy showed the highest TTF in oligodendrogliomas.
KW  - Low grade glioma
KW  - Astrocytoma
KW  - Oligodendroglioma
KW  - Grading
KW  - Treatment outcome
KW  - Temozolomide
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/63742
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-637423
SN  - 1432-1335
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 147
IS  - 8
SP  - 2373
EP  - 2383
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -