Postsurgical Approaches in Low-Grade Oligodendroglioma: Is Chemotherapy Alone Still an Option?

Enrico Franceschi, Alicia Tosoni, Dario De Biase, Giuseppe Lamberti, Daniela Danieli, Stefano Pizzolitto, Elena Zunarelli, Michela Visani, Enrico Di Oto, Antonella Mura, Santino Minichillo, Chiara Scafati, Sofia Asioli, Alexandro Paccapelo, Stefania Bartolini, Alba A. Brandes

Research output: Contribution to journalArticle

Abstract

Background: Patients with low-grade gliomas (LGGs) with isocitrate dehydrogenase (IDH) 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 IDH mut and 1p19q codel; IDH1/2 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. Results: 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, n = 26, 113.8 months, 95% CI: 57.2–170.5) than those who did not (n = 67, 47.3 months, 95% CI: 36.4–58.2). In particular, temozolomide alone did not improve PFS with respect to FU. Conclusion: RT with or without chemotherapy, but not temozolomide alone, could extend PFS in IDH mut 1p19q codel LGGs. Implications for Practice: 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.

Original languageEnglish
Pages (from-to)664-670
Number of pages7
JournalOncologist
Volume24
Issue number5
DOIs
Publication statusPublished - May 1 2019

Fingerprint

Oligodendroglioma
Radiotherapy
Drug Therapy
temozolomide
Isocitrate Dehydrogenase
Glioma
Mutation
Confidence Intervals
Disease-Free Survival
Radiation Oncology
Survival
Therapeutics
Combination Drug Therapy
Fluorescence In Situ Hybridization

Keywords

  • 1p19q codeletion
  • Isocitrate dehydrogenase mutation
  • Low-grade glioma
  • Next-generation sequencing
  • Postsurgical treatment

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Franceschi, E., Tosoni, A., De Biase, D., Lamberti, G., Danieli, D., Pizzolitto, S., ... Brandes, A. A. (2019). Postsurgical Approaches in Low-Grade Oligodendroglioma: Is Chemotherapy Alone Still an Option? Oncologist, 24(5), 664-670. https://doi.org/10.1634/theoncologist.2018-0549

Postsurgical Approaches in Low-Grade Oligodendroglioma : Is Chemotherapy Alone Still an Option? / Franceschi, Enrico; Tosoni, Alicia; De Biase, Dario; Lamberti, Giuseppe; Danieli, Daniela; Pizzolitto, Stefano; Zunarelli, Elena; Visani, Michela; Di Oto, Enrico; Mura, Antonella; Minichillo, Santino; Scafati, Chiara; Asioli, Sofia; Paccapelo, Alexandro; Bartolini, Stefania; Brandes, Alba A.

In: Oncologist, Vol. 24, No. 5, 01.05.2019, p. 664-670.

Research output: Contribution to journalArticle

Franceschi, E, Tosoni, A, De Biase, D, Lamberti, G, Danieli, D, Pizzolitto, S, Zunarelli, E, Visani, M, Di Oto, E, Mura, A, Minichillo, S, Scafati, C, Asioli, S, Paccapelo, A, Bartolini, S & Brandes, AA 2019, 'Postsurgical Approaches in Low-Grade Oligodendroglioma: Is Chemotherapy Alone Still an Option?', Oncologist, vol. 24, no. 5, pp. 664-670. https://doi.org/10.1634/theoncologist.2018-0549
Franceschi E, Tosoni A, De Biase D, Lamberti G, Danieli D, Pizzolitto S et al. Postsurgical Approaches in Low-Grade Oligodendroglioma: Is Chemotherapy Alone Still an Option? Oncologist. 2019 May 1;24(5):664-670. https://doi.org/10.1634/theoncologist.2018-0549
Franceschi, Enrico ; Tosoni, Alicia ; De Biase, Dario ; Lamberti, Giuseppe ; Danieli, Daniela ; Pizzolitto, Stefano ; Zunarelli, Elena ; Visani, Michela ; Di Oto, Enrico ; Mura, Antonella ; Minichillo, Santino ; Scafati, Chiara ; Asioli, Sofia ; Paccapelo, Alexandro ; Bartolini, Stefania ; Brandes, Alba A. / Postsurgical Approaches in Low-Grade Oligodendroglioma : Is Chemotherapy Alone Still an Option?. In: Oncologist. 2019 ; Vol. 24, No. 5. pp. 664-670.
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title = "Postsurgical Approaches in Low-Grade Oligodendroglioma: Is Chemotherapy Alone Still an Option?",
abstract = "Background: Patients with low-grade gliomas (LGGs) with isocitrate dehydrogenase (IDH) 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 IDH mut and 1p19q codel; IDH1/2 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. Results: 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, n = 26, 113.8 months, 95{\%} CI: 57.2–170.5) than those who did not (n = 67, 47.3 months, 95{\%} CI: 36.4–58.2). In particular, temozolomide alone did not improve PFS with respect to FU. Conclusion: RT with or without chemotherapy, but not temozolomide alone, could extend PFS in IDH mut 1p19q codel LGGs. Implications for Practice: 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.",
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author = "Enrico Franceschi and Alicia Tosoni and {De Biase}, Dario and Giuseppe Lamberti and Daniela Danieli and Stefano Pizzolitto and Elena Zunarelli and Michela Visani and {Di Oto}, Enrico and Antonella Mura and Santino Minichillo and Chiara Scafati and Sofia Asioli and Alexandro Paccapelo and Stefania Bartolini and Brandes, {Alba A.}",
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TY - JOUR

T1 - Postsurgical Approaches in Low-Grade Oligodendroglioma

T2 - Is Chemotherapy Alone Still an Option?

AU - Franceschi, Enrico

AU - Tosoni, Alicia

AU - De Biase, Dario

AU - Lamberti, Giuseppe

AU - Danieli, Daniela

AU - Pizzolitto, Stefano

AU - Zunarelli, Elena

AU - Visani, Michela

AU - Di Oto, Enrico

AU - Mura, Antonella

AU - Minichillo, Santino

AU - Scafati, Chiara

AU - Asioli, Sofia

AU - Paccapelo, Alexandro

AU - Bartolini, Stefania

AU - Brandes, Alba A.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Patients with low-grade gliomas (LGGs) with isocitrate dehydrogenase (IDH) 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 IDH mut and 1p19q codel; IDH1/2 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. Results: 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, n = 26, 113.8 months, 95% CI: 57.2–170.5) than those who did not (n = 67, 47.3 months, 95% CI: 36.4–58.2). In particular, temozolomide alone did not improve PFS with respect to FU. Conclusion: RT with or without chemotherapy, but not temozolomide alone, could extend PFS in IDH mut 1p19q codel LGGs. Implications for Practice: 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.

AB - Background: Patients with low-grade gliomas (LGGs) with isocitrate dehydrogenase (IDH) 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 IDH mut and 1p19q codel; IDH1/2 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. Results: 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, n = 26, 113.8 months, 95% CI: 57.2–170.5) than those who did not (n = 67, 47.3 months, 95% CI: 36.4–58.2). In particular, temozolomide alone did not improve PFS with respect to FU. Conclusion: RT with or without chemotherapy, but not temozolomide alone, could extend PFS in IDH mut 1p19q codel LGGs. Implications for Practice: 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.

KW - 1p19q codeletion

KW - Isocitrate dehydrogenase mutation

KW - Low-grade glioma

KW - Next-generation sequencing

KW - Postsurgical treatment

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