Erin S Murphy1, Charles M Leyrer2, Michael Parsons3, John H Suh4, Samuel T Chao4, Jennifer S Yu4, Rupesh Kotecha2, Xuefei Jia5, David M Peereboom6, Richard A Prayson7, Glen H J Stevens8, Gene H Barnett9, Michael A Vogelbaum9, Manmeet S Ahluwalia6. 1. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio. Electronic address: murphye3@ccf.org. 2. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. 3. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio; Center for Behavioral Health, Cleveland Clinic, Cleveland, Ohio; Department of Neurological Sciences, Center for Brain Health, Cleveland Clinic, Cleveland, Ohio. 4. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio. 5. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 6. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. 7. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio; Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio. 8. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio. 9. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
PURPOSE: The incidence, risk factors, and outcomes of low-grade glioma patients who undergo malignant transformation (MT) in the era of temozolomide are not well known. This study evaluates these factors in a large group of World Health Organization grade 2 glioma patients treated at a tertiary-care institution. METHODS AND MATERIALS: Patient, tumor, and treatment factors were analyzed using an institutional review board-approved low-grade glioma database. Characteristics were compared using χ2 and Wilcoxon signed rank tests. Time to event was summarized using proportional hazards models. Univariate and multivariate survival analyses were performed. RESULTS: Of a total of 599 patients, 124 underwent MT; 76 (61.3%) had biopsy-proven MT. The MT incidence was 21%, and the median time to MT was 56.4 months. The 5- and 10-year progression-free survival rates were 30.6% ± 4.2% and 4.8% ± 1.9%, respectively, for MT patients and 60% ± 2.4% and 38% ± 2.7%, respectively, for non-MT patients. The 5- and 10-year overall survival rates were 75% ± 4.0% and 46% ± 5.0%, respectively, for MT patients and 87% ± 1.7% and 78% ± 2.3%, respectively, for non-MT patients. On multivariate analysis, older age (P = .001), male sex (P = .004), multiple tumor locations (P = .004), chemotherapy alone (P = .012), and extent of resection (P = .045) remained significant predictors of MT. CONCLUSIONS: MT affects survival. Risk factors include older age, male sex, multiple tumor locations, use of chemotherapy alone, and presence of residual disease. Our finding that initial interventions could affect the rate of MT is provocative, but these data should be validated using data from prospective trials. In addition to improving survival, future therapeutic efforts should focus on preventing MT.
PURPOSE: The incidence, risk factors, and outcomes of low-grade gliomapatients who undergo malignant transformation (MT) in the era of temozolomide are not well known. This study evaluates these factors in a large group of World Health Organization grade 2 gliomapatients treated at a tertiary-care institution. METHODS AND MATERIALS: Patient, tumor, and treatment factors were analyzed using an institutional review board-approved low-grade glioma database. Characteristics were compared using χ2 and Wilcoxon signed rank tests. Time to event was summarized using proportional hazards models. Univariate and multivariate survival analyses were performed. RESULTS: Of a total of 599 patients, 124 underwent MT; 76 (61.3%) had biopsy-proven MT. The MT incidence was 21%, and the median time to MT was 56.4 months. The 5- and 10-year progression-free survival rates were 30.6% ± 4.2% and 4.8% ± 1.9%, respectively, for MT patients and 60% ± 2.4% and 38% ± 2.7%, respectively, for non-MT patients. The 5- and 10-year overall survival rates were 75% ± 4.0% and 46% ± 5.0%, respectively, for MT patients and 87% ± 1.7% and 78% ± 2.3%, respectively, for non-MT patients. On multivariate analysis, older age (P = .001), male sex (P = .004), multiple tumor locations (P = .004), chemotherapy alone (P = .012), and extent of resection (P = .045) remained significant predictors of MT. CONCLUSIONS: MT affects survival. Risk factors include older age, male sex, multiple tumor locations, use of chemotherapy alone, and presence of residual disease. Our finding that initial interventions could affect the rate of MT is provocative, but these data should be validated using data from prospective trials. In addition to improving survival, future therapeutic efforts should focus on preventing MT.
Authors: Deborah Y Park; Martin C Tom; Yanwen Chen; Surabhi Tewari; Manmeet S Ahluwalia; Jennifer S Yu; Samuel T Chao; John H Suh; David M Peereboom; Glen H J Stevens; Gene H Barnett; Lilyana Angelov; Alireza Mohammadi; Thomas Hogan; Courtney Kissel; Brittany Lapin; Isabel Schuermeyer; Michael W Parsons; Richard Naugle; Erin S Murphy Journal: J Neurooncol Date: 2022-04-29 Impact factor: 4.130
Authors: Elena Jansen; Christina Hamisch; Daniel Ruess; Dieter Henrik Heiland; Roland Goldbrunner; Maximilian I Ruge; Oliver Schnell; Stefan J Grau Journal: J Neurooncol Date: 2019-10-16 Impact factor: 4.130
Authors: Deborah Y Park; Martin C Tom; Wei Wei; Surabhi Tewari; Manmeet S Ahluwalia; Jennifer S Yu; Samuel T Chao; John H Suh; David Peereboom; Glen H J Stevens; Gene H Barnett; Lilyana Angelov; Alireza M Mohammadi; Thomas Hogan; Courtney Kissel; Brittany Lapin; Isabel Schuermeyer; Michael W Parsons; Richard Naugle; Erin S Murphy Journal: J Neurooncol Date: 2022-01-22 Impact factor: 4.130
Authors: Ramin A Morshed; Seunggu J Han; Shawn L Hervey-Jumper; Melike Pekmezci; Irene Troncon; Susan M Chang; Nicholas A Butowski; Mitchel S Berger Journal: J Neurooncol Date: 2018-11-29 Impact factor: 4.506