Maximizing Resection Correlate with Positive Prognosis for Adult WHO Grade II Gliomas at Diagnosis and Recurrence
The largest modern series of 1097 WHO Grade II gliomas (with MRI-verified tumor sizes) collected by the multi-center French Glioma Research Group from January 1985 to December 2007 (mean 7.4 year follow-up) was reported in Journal of Neurosurgery (June 2013). Inclusion criteria were age>18, WHO Grade II glioma and MRI-quantified tumor sizes pre- and post-treatment. Deep (thalamic or ventricular) and disseminated lesions were excluded. At diagnosis, poor prognosis associated with age>55 years, KPS<80, non-frontal location and larger tumor size (consistent with USCF scoring system). Initial or delayed use of radiotherapy prolongs progression-free survival, but did not improve overall survival, and chemotherapy did not significantly affect survival. Multivariate Cox analysis revealed that smaller tumor volume (pre-op, postop and at recurrence) is associated with better survival. Analysis of this large series offers robust support to the thesis that optimal, aggressive and repeated surgical resection (when possible) contributes significant benefit at all natural history stages of Grade II gliomas.