Taeryool Koo1, Do Hoon Lim2, Ho Jun Seol3, Yun-Sik Dho4, Il Han Kim5, Jong Hee Chang6, Jeongshim Lee7, Tae-Young Jung8, Ho-Shin Gwak9, Kwan Ho Cho10, Chang-Ki Hong11, Ik Jae Lee12, El Kim13, Jin Hee Kim14, Yong-Kil Hong15, Hong Seok Jang16, Chae-Yong Kim17, In Ah Kim18, Sung Hwan Kim19, Young Il Kim20, Eun-Young Kim21, Woo Chul Kim22, Semie Hong23. 1. Department of Radiation Oncology, Hallym University Sacred Heart Hospital, Anyang, South Korea. 2. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea. dh8lim@skku.edu. 3. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 4. Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea. 5. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea. 6. Department of Neurosurgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea. 7. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea. 8. Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, South Korea. 9. Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea. 10. Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea. 11. Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 12. Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. 13. Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea. 14. Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea. 15. Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 16. Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 17. Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea. 18. Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea. 19. Department of Radiation Oncology, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea. 20. Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, South Korea. 21. Department of Neurosurgery, Inha University Hospital, Inha University of Medicine, Inchon, South Korea. 22. Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, South Korea. 23. Department of Radiation Oncology, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea.
Abstract
INTRODUCTION: Optimal treatment strategies for low-grade glioma (LGG) remain controversial. We analyzed treatment outcomes and evaluated prognostic factors of adult LGG patients in Korea. METHODS: We reviewed the medical records of 555 patients diagnosed with WHO grade II LGG (astrocytoma 37.8%, oligoastrocytoma 15.3%, and oligodendroglioma 46.8%) at 14 institutions between 2000 and 2010. Primary and secondary endpoints were progression-free survival (PFS) and overall survival (OS). Propensity-score matching (PSM) analyses were performed to correct imbalances in patient/tumor characteristics among adjuvant treatment groups. RESULTS: The median follow-up time was 83.4 months, and the 5-year PFS and OS rates were 52.2% and 83.0%, respectively. Male, older age, poorer performance status, multiple lobe involvement, and astrocytoma histology were associated with poorer survival. Among the treatment factors, gross total resection (GTR) was associated with better PFS and OS, and adjuvant chemotherapy with improved PFS. Interestingly, adjuvant radiotherapy (RT) did not improve PFS; rather, it was related with poorer OS. Regarding patient/tumor characteristics, the RT group had poorer characteristics than the non-RT group. After PSM, we detected a tendency for improved PFS in the matched RT group, and no significant difference in OS compared with the matched non-RT group. CONCLUSIONS: The achievement of GTR is important to improve survival in LGG patients. Adjuvant chemotherapy may enhance PFS, but adjuvant RT did not improve survival outcomes. After PSM, we observed potential impacts of adjuvant RT on PFS. Our results may reflect real-world practice and consequently may help to optimize treatment strategies for LGG.
INTRODUCTION: Optimal treatment strategies for low-grade glioma (LGG) remain controversial. We analyzed treatment outcomes and evaluated prognostic factors of adult LGG patients in Korea. METHODS: We reviewed the medical records of 555 patients diagnosed with WHO grade II LGG (astrocytoma 37.8%, oligoastrocytoma 15.3%, and oligodendroglioma 46.8%) at 14 institutions between 2000 and 2010. Primary and secondary endpoints were progression-free survival (PFS) and overall survival (OS). Propensity-score matching (PSM) analyses were performed to correct imbalances in patient/tumor characteristics among adjuvant treatment groups. RESULTS: The median follow-up time was 83.4 months, and the 5-year PFS and OS rates were 52.2% and 83.0%, respectively. Male, older age, poorer performance status, multiple lobe involvement, and astrocytoma histology were associated with poorer survival. Among the treatment factors, gross total resection (GTR) was associated with better PFS and OS, and adjuvant chemotherapy with improved PFS. Interestingly, adjuvant radiotherapy (RT) did not improve PFS; rather, it was related with poorer OS. Regarding patient/tumor characteristics, the RT group had poorer characteristics than the non-RT group. After PSM, we detected a tendency for improved PFS in the matched RT group, and no significant difference in OS compared with the matched non-RT group. CONCLUSIONS: The achievement of GTR is important to improve survival in LGG patients. Adjuvant chemotherapy may enhance PFS, but adjuvant RT did not improve survival outcomes. After PSM, we observed potential impacts of adjuvant RT on PFS. Our results may reflect real-world practice and consequently may help to optimize treatment strategies for LGG.
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