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  • Low Grade Gliomas: Defining The Best Clinical Approach in the Multiply Deleted Patient

    Final Number:

    Tiffany L Powell MD; Evan D Bander; Rachael A Venn; Akbarshakh Akhmerov; Gustav Y Cederquist; Peter M Schaefer; Luis A Puchi; Emma Olcott; Jason Huse MD; Anne Reiner MPH; Viviane S. Tabar MD

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    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Recent advances in our understanding of the biology of low grade gliomas (LGGs) have highlighted the importance of molecular classification of these tumors. 1p/19q co-deletion and IDH mutational status have emerged as positive prognosticators. However, clinical strategies are lagging behind and continue to be debated. We present a prototype of an interactive database that integrates clinical and molecular annotations allowing multi-parameter queries for clinical and research purposes. We also aim to use the database to answer specific research questions, can the combined clinical and molecular profile of a LGG at diagnosis be used to predict the best overall treatment strategy with regards to timing of surgery, radiation and chemotherapy.

    Methods: Over a twenty-year period, 434 cases of LGGs were identified and treated at Memorial Sloan Kettering Cancer Center. Key clinical parameters were entered into a database. Availability of pathology information varied from simple histologic WHO grading to FISH for 1p/19q and immunohistochemistry for IDH status. Retrospective testing for 1p/19q and IDH status was performed whenever possible. In addition, we imported a more comprehensive molecular profile that uses a Nanostring platform for the multiplexed profiling of multiple genes.

    Results: At this time, preliminary analysis is available for 185 patients, 44.5 % were female and 55.4% were male. 23% received a biopsy as the primary surgical intervention, 43.6% underwent subtotal and 23% received gross total resections. Mean time to recurrence was 36 months, 55 months and 80 months for biopsy, subtotal and gross total resection respectively. Mutated IDH was identified in 87%, 1p/19q co-deletions were found in 58% of samples. 63% of patients received radiation and 68% of patients received chemotherapy at some point during treatment.

    Conclusions: : An active database that contains clinical and corresponding molecular details will greatly aid collaborative research and be used to predict the best overall treatment strategies with regards to timing of surgery, radiation and chemotherapy in LGGs.

    Patient Care: Identifying the best treatment approach and timing of treatment for patients with low grade gliomas will prevent patients from being subjected to surgical procedures, radiation or chemotherapy that does not offer improved survival.

    Learning Objectives: By the conclusion of this session participants should be able to identify an effective treatment for certain molecular and clinical profiles of Low Grade Gliomas.


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