Introduction: The goal of this study was to assess the impact of intraoperative magnetic resonance imaging (iMRI), extent of resection (EOR), and other factors on overall survival (OS) and progression-free survival (PFS) for patients with newly diagnosed World Health Organization (WHO) grade I gliomas.
Methods: A multicenter mixed retrospective/prospective database was queried to identify patients with grade I gliomas. Retrospective analyses assessed the impact of patient, treatment, and tumor characteristics, including EOR (gross, near, and subtotal total resection (GTR, NTR, and STR)), on OS and PFS.
Results: Two-hundred ninety-two patients (mean age 26.9 years, range 3-88) were identified who underwent treatment at initial diagnosis for grade I gliomas. Of these, 255 treatments were resections (208 with iMRI, 47 without), 37 were biopsies, and 13 were laser interstitial thermal therapy treatments (LITT). Kaplan-Meier survival plots showed over 90% 10-year OS for all patients. Log-rank analyses showed improved OS for lower age (p = 0.02) and American Society of Anesthesiologists (ASA) score (p = 0.05), improved 5-year survival with increased EOR (GTR/NTR versus STR/biopsy/LITT) (p = 0.03), and a trend towards improved 5-year OS for iMRI versus no iMRI (p = 0.086). PFS improved with lower ASA score (p = 0.05), increased EOR (p = 0.005), and temporal (p = 0.04), corpus callosum/insular (p = 0.04), and non-parietal (p = 0.02) locations. Conversely, univariate analysis indicated that only age was predictive of improved OS, and no other prognosticators (iMRI, EOR, location, gender, age, ASA score) were associated with improved OS or PFS.
Conclusions: Analysis of a large multicenter database showed extended OS and PFS for patients with WHO grade I gliomas, and indicated that age, ASA score, EOR and iMRI may impact outcomes in this population.
Patient Care: By including data from many institutions in both the United States and Canada, this study allows us to make more generalizable conclusions regarding patients with grade I gliomas.The analysis in the current multicenter study provides new insights into the prognostic factors impacting newly diagnosed grade I gliomas and unique data regarding the impact of iMRI. The large volume of patients collected from this multicenter registry is the largest study of its kind to date. This study will help inform clinical practice for treating patients with these tumors.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe clinical features and prognostic factors associated with OS and PFS for grade I gliomas.
2) Discuss how these clinical factors may be used to improve the treatment of patients with grade I gliomas.
3) Identify the most effective treatment for extending OS and PFS for grade I gliomas.