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Early removal of low-grade gliomas appears more effective than watchful waiting
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Early resection was associated with significantly better survival outcomes among patients with diffuse low-grade gliomas than a treatment regimen that favored biopsy and watchful waiting, according to results of a study conducted in Norway.
Asgeir S. Jakola, MD, of the department of neurosurgery at St. Olavs Hospital in Trondheim, analyzed data from patients treated at two university hospitals in Norway between 1998 and 2009. Follow-up ended on April 11, 2011.
The hospitals are in different regions of the country and have different referral practices. One hospital favors a wait-and-scan approach after biopsy, and the other advocates early resections.
The analysis included 66 patients in the biopsy and watchful waiting cohort and 87 patients in the early resection cohort. All patients had comparable baseline characteristics.
The median follow-up duration was 7 years (interquartile range [IQR], 4.5-10.9) at the watchful waiting hospital and 7.1 years (IQR, 4.2-9.9) at the surgical resection hospital.
OS — based on regional comparisons without adjusting for administered treatment — served as the primary outcome measure.
Initial biopsy alone was performed on 71% of patients in the watchful waiting group and 14% of patients in the early resection group (P<.001).
Early resection was associated with significant improvements in OS (P=.01). Biopsy and watchful waiting was associated with a median survival of 5.9 years (95% CI, 4.5-7.3). Median survival was not reached in the early resection cohort.
Estimated 5-year survival in the early resection group was 74% (95% CI, 64-84) compared with 60% (95% CI, 48-72) in the biopsy and watchful waiting group.
Multivariate analysis results indicated a relative HR for survival of 1.8 (95% CI, 1.1-2.9) for treatment at the hospital that favored biopsy and watchful waiting.
In an accompanying editorial, James M. Markert, MD, of the division of neurosurgery in the department of surgery at the University of Alabama at Birmingham, said the potential difference in survival “provides important data to help inform the complex question of whether to attempt aggressive [low-grade glioma] resection.”
Although there is a paucity of evidence for surgical resection in this patient population, National Comprehensive Cancer Network guidelines in oncology support maximal safe resection as a feasible first-line approach.
“The majority of these studies, but not all studies published in the past 2 decades, support this approach as well,” Markert wrote. “The study by Jakola et al adds further evidence for this approach. A follow-up study of their cohorts, allowing for more definitive measurement of survival and more rigorous assessment of complications, neurologic deterioration and malignant degeneration, would be valuable.”
Disclosure: See study for a full list of financial disclosures.
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