Jaymin Jhaveri1, Yuan Liu2, Mudit Chowdhary1,3, Zachary S Buchwald1, Theresa W Gillespie4, Jeffrey J Olson5, Alfredo D Voloschin6, Bree R Eaton1, Hui-Kuo G Shu1, Ian R Crocker1, Walter J Curran1, Kirtesh R Patel1,7. 1. Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia. 2. Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia. 3. Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois. 4. Department of Surgery and Winship Cancer Institute, Emory University, Atlanta, Georgia. 5. Department of Neurosurgery and Winship Cancer Institute, Emory University, Atlanta, Georgia. 6. Department of Hematology and Medical Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia. 7. Department of Therapeutic Radiology and Smilow Cancer Center, Yale School of Medicine, New Haven, Connecticut.
Abstract
BACKGROUND: The addition of chemotherapy to adjuvant radiotherapy (chemotherapy and radiation therapy [CRT]) improves overall survival (OS) for patients with high-risk grade 2 gliomas; however, the impact of chemotherapy alone (CA) is unknown. This study compares the OS of patients with high-risk grade 2 gliomas treated with CA versus CRT. METHODS: Patients with high-risk grade 2 gliomas (subtotal resection or age ≥ 40 years) with oligodendrogliomas, astrocytomas, or mixed tumors were identified with the National Cancer Data Base. Patients were grouped into CA and CRT cohorts. Univariate analyses and multivariate analyses (MVAs) were performed. Propensity score (PS) matching was also implemented. The Kaplan-Meier method was used to analyze OS. RESULTS: A total of 1054 patients with high-risk grade 2 gliomas were identified: 496 (47.1%) received CA, and 558 (52.9%) received CRT. Patients treated with CA were more likely (all P values < .05) to have oligodendroglioma histology (65.5% vs 34.2%), exhibit a 1p/19q codeletion (22.8% vs 7.5%), be younger (median age, 47.0 vs 48.0 years), and receive treatment at an academic facility (65.2% vs 50.3%). The treatment type was not a significant predictor for OS (P = .125) according to the MVA; a tumor size > 6 cm, astrocytoma histology, and older age were predictors for worse OS (all P values < .05). After 1:1 PS matching (n = 331 for each cohort), no OS difference was seen (P = .696) between the CA and CRT cohorts at 5 (69.3% vs 67.4%) and 8 years (52.8% vs 56.7%). CONCLUSIONS: No long-term OS difference was seen in patients with high-risk grade 2 gliomas treated with CA versus CRT. These findings are hypothesis-generating, and prospective clinical trials comparing these treatment paradigms are warranted. Cancer 2018;124:1169-78.
BACKGROUND: The addition of chemotherapy to adjuvant radiotherapy (chemotherapy and radiation therapy [CRT]) improves overall survival (OS) for patients with high-risk grade 2 gliomas; however, the impact of chemotherapy alone (CA) is unknown. This study compares the OS of patients with high-risk grade 2 gliomas treated with CA versus CRT. METHODS:Patients with high-risk grade 2 gliomas (subtotal resection or age ≥ 40 years) with oligodendrogliomas, astrocytomas, or mixed tumors were identified with the National Cancer Data Base. Patients were grouped into CA and CRT cohorts. Univariate analyses and multivariate analyses (MVAs) were performed. Propensity score (PS) matching was also implemented. The Kaplan-Meier method was used to analyze OS. RESULTS: A total of 1054 patients with high-risk grade 2 gliomas were identified: 496 (47.1%) received CA, and 558 (52.9%) received CRT. Patients treated with CA were more likely (all P values < .05) to have oligodendroglioma histology (65.5% vs 34.2%), exhibit a 1p/19q codeletion (22.8% vs 7.5%), be younger (median age, 47.0 vs 48.0 years), and receive treatment at an academic facility (65.2% vs 50.3%). The treatment type was not a significant predictor for OS (P = .125) according to the MVA; a tumor size > 6 cm, astrocytoma histology, and older age were predictors for worse OS (all P values < .05). After 1:1 PS matching (n = 331 for each cohort), no OS difference was seen (P = .696) between the CA and CRT cohorts at 5 (69.3% vs 67.4%) and 8 years (52.8% vs 56.7%). CONCLUSIONS: No long-term OS difference was seen in patients with high-risk grade 2 gliomas treated with CA versus CRT. These findings are hypothesis-generating, and prospective clinical trials comparing these treatment paradigms are warranted. Cancer 2018;124:1169-78.
Authors: Hassan M Fathallah-Shaykh; Andrew DeAtkine; Elizabeth Coffee; Elias Khayat; Asim K Bag; Xiaosi Han; Paula Province Warren; Markus Bredel; John Fiveash; James Markert; Nidhal Bouaynaya; Louis B Nabors Journal: PLoS Med Date: 2019-05-28 Impact factor: 11.069
Authors: Mudit Chowdhary; Anna Lee; Sarah Gao; Dian Wang; Parul N Barry; Roberto Diaz; Neeti R Bagadiya; Henry S Park; James B Yu; Lynn D Wilson; Meena S Moran; Susan A Higgins; Christin A Knowlton; Kirtesh R Patel Journal: Front Oncol Date: 2019-01-14 Impact factor: 6.244
Authors: Amélie Darlix; Emmanuel Mandonnet; Christian F Freyschlag; Daniel Pinggera; Marie-Therese Forster; Martin Voss; Joachim Steinbach; Carmel Loughrey; John Goodden; Giuseppe Banna; Concetta Di Blasi; Nicolas Foroglou; Andreas F Hottinger; Marie-Hélène Baron; Johan Pallud; Hugues Duffau; Geert-Jan Rutten; Fabien Almairac; Denys Fontaine; Luc Taillandier; Catarina Pessanha Viegas; Luisa Albuquerque; Gord von Campe; Tadeja Urbanic-Purkart; Marie Blonski Journal: Neurooncol Pract Date: 2018-12-13