Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL, IRCCS Institute of Neurological Sciences, Bologna, Italy.
Department of Pharmacy and Biotechnology - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, Bologna, Italy.
Oncologist. 2019 May;24(5):664-670. doi: 10.1634/theoncologist.2018-0549. Epub 2019 Feb 18.
Patients with low-grade gliomas (LGGs) with isocitrate dehydrogenase () mutation (mut) and 1p19q codeletion (codel) have a median overall survival of longer than 10 years. The aim of this study is to assess the role of postsurgical treatments.
SUBJECTS, MATERIALS, AND METHODS: We evaluated patients with LGGs with mut and 1p19q codel; was performed by immunohistochemistry and quantitative polymerase chain reaction. In all wild-type cases, we performed next-generation sequencing. 1p19 codel analysis was performed by fluorescence in situ hybridization.
Among the 679 patients, 93 with LGGs with IDH mutation and 1p19q codel were included. Median follow-up (FU) was 96.1 months. Eighty-four patients (90.3%) were high risk according to Radiation Therapy Oncology Group criteria. After surgery, 50 patients (53.7%) received only FU, 17 (18.3%) chemotherapy (CT), and 26 (30.1%) radiotherapy (RT) with (RT + CT, 8 patients, 8.6%) or without (RT, 18 patients, 19.4%) chemotherapy. Median progression-free survival (mPFS) was 46.3 months, 50.8 months, 103.6 months, and 120.2 months in patients with FU alone, with CT alone, with RT alone, or with RT + CT, respectively. Median PFS was significantly longer in patients who received postsurgical treatment (79.5 months, 95% confidence interval [CI]: 66.4-92.7) than patients who received FU (46.3 months, 95% CI: 36.0-56.5). Moreover, mPFS was longer in patients who received RT (alone or in combination with CT, = 26, 113.8 months, 95% CI: 57.2-170.5) than those who did not ( = 67, 47.3 months, 95% CI: 36.4-58.2). In particular, temozolomide alone did not improve PFS with respect to FU.
RT with or without chemotherapy, but not temozolomide alone, could extend PFS in IDH mut 1p19q codel LGGs.
Low-grade gliomas with high-risk features, defined according to Radiation Therapy Oncology Group criteria, receive radiotherapy and/or chemotherapy as postsurgical treatments. Radiotherapy, however, has serious long-term effects (cognitive impairment), which are to be taken into account in these young patients. Moreover, low-grade gliomas with isocitrate dehydrogenase mutation and 1p19q codeletion (oligodendrogliomas) have an extremely long survival and a better prognosis. This study suggests that postsurgical treatments prolong the time before tumor progression in patients with good prognosis as well as those with oligodendroglioma. Moreover, temozolomide alone might not be effective in prolonging progression-free survival.
伴 IDH 突变和 1p19q 联合缺失的低级别胶质瘤（LGG）患者的中位总生存期超过 10 年。本研究旨在评估术后治疗的作用。
受试者、材料和方法：我们评估了伴 IDH 突变和 1p19q 联合缺失的 LGG 患者；通过免疫组化和定量聚合酶链反应检测。在所有野生型病例中，我们进行了下一代测序。1p19 联合缺失的分析通过荧光原位杂交进行。
在 679 例患者中，有 93 例 LGG 伴 IDH 突变和 1p19q 联合缺失。中位随访（FU）时间为 96.1 个月。84 例患者（90.3%）根据放射治疗肿瘤学组标准为高危。手术后，50 例（53.7%）患者仅接受 FU，17 例（18.3%）接受化疗（CT），26 例（30.1%）接受放疗（RT），其中 8 例（8.6%）联合化疗（RT+CT），18 例（19.4%）单纯 RT。单独接受 FU、单独接受 CT、单独接受 RT 或接受 RT+CT 的患者的无进展生存期（mPFS）分别为 46.3 个月、50.8 个月、103.6 个月和 120.2 个月。接受术后治疗的患者的中位 PFS 明显长于接受 FU 的患者（79.5 个月，95%置信区间[CI]：66.4-92.7），而接受 FU 的患者为 46.3 个月（95%CI：36.0-56.5）。此外，接受 RT（单独或联合 CT）的患者的 mPFS 长于未接受 RT 的患者（ = 26，113.8 个月，95%CI：57.2-170.5），而未接受 RT 的患者为 67 个月（95%CI：47.3 个月，95%CI：36.4-58.2）。特别是，替莫唑胺单独治疗与 FU 相比并不能改善 PFS。
伴 IDH 突变和 1p19q 联合缺失的 LGG 患者，伴高危特征（根据放射治疗肿瘤学组标准定义）接受放疗和/或化疗作为术后治疗。然而，放疗有严重的长期影响（认知障碍），这在这些年轻患者中需要考虑。此外，伴 IDH 突变和 1p19q 联合缺失（少突胶质细胞瘤）的低级别胶质瘤患者的生存期极长，预后良好。本研究表明，术后治疗不仅能延长预后良好患者的肿瘤进展时间，也能延长少突胶质细胞瘤患者的肿瘤进展时间。此外，替莫唑胺单独治疗可能无法延长无进展生存期。
