(P032) Current Management of Low-Grade Central Nervous System Glioma
Currently, low-grade glioma is commonly treated in the community setting by RT alone. A relatively high rate of local failure is noted (28%), and long-term survival appears to be shorter than might be expected. A number of patients are treated based on imaging alone without a detriment to survival. Low-grade glioma appears to be a more aggressive disease than usually considered, and efforts to improve the outcome would be served through clinical trials.
Ron R. Allison, MD, Dioval Reymond, Sharon Salenius, MPH, Andrej Hnatov, MD, Cynthia Ballenger, MD, Constantine Mantz, MD, Eduardo Fernandez, MD, PhD, Daniel Dosoretz, MD, Vershalee Shukla, MD, Timothy Shafman, MD, Steven Finkelstein, MD; 21st Century Oncology; The Brody School of Medicine, East Carolina University
BACKGROUND: Low-grade central nervous system (CNS) glioma is a rare diagnosis but is becoming more common as neuroimaging is now often undertaken for headache and other nonspecific neurologic signs and symptoms. Current management may include resection alone, radiation alone, or their combination, with chemotherapy as an adjunct. We reviewed the current management for this diagnosis based on a large cohort of freestanding and hospital-based cancer centers.
MATERIALS AND METHODS: An institutional review board (IRB)-approved chart review for all patients with low-grade primary CNS glioma who were treated at our facilities between 1989 and 2012 was undertaken. This search returned 25 patients (10 males, 15 females; mean age: 50.5 yr). Twenty patients were Caucasian. Presenting signs and symptoms were nonspecific CNS complaints: mainly generalized headache, vision changes, numbness, and weakness. Workup included magnetic resonance imaging (MRI) and/or computed tomography (CT). Biopsy reported low-gradeglioma, though imaging alone was used for diagnosis in some patients. Only two patients underwent gross total resection, and one patient underwent surgical debulking. All patients underwent external beam radiation therapy (RT), usually intensity-modulated RT (IMRT) or three-dimensional (3D) treatment with a mean dose of 48.6 Gy. Image guidance was employed in 24% of patients. Temodar was delivered to six patients (24%).
RESULTS: All patients have been followed for a mean of 9.3 months (range: 0.3–153.3 mo). Most patients were considered unresectable.RT was well tolerated, with most complications being grade I/II. One patient developed seizures as a late complication. All failures were local, occurring in 28% of patients. With regard to survival, eight patients are currently alive (32%). Statistical analysis showed no survival advantage for gender, age, performance status, biopsy, IMRT, radiation dose, chemotherapy, or surgery.
CONCLUSION: Currently, low-grade glioma is commonly treated in the community setting by RT alone. A relatively high rate of local failure is noted (28%), and long-term survival appears to be shorter than might be expected. A number of patients are treated based on imaging alone without a detriment to survival. Low-grade glioma appears to be a more aggressive disease than usually considered, and efforts to improve the outcome would be served through clinical trials.
Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org
