Management of Patients With Low-Grade Gliomas – A Survey Among German Neurosurgical Departments

Abstract

Background and aims of the study: The diagnosis and treatment of low-grade gliomas (LGG) are multimodal. Today, there is no defined standard in diagnosis and treatment. Controversies are, in general, about a “wait-and-see” strategy, diagnostic workup, surgical intervention, postoperative imaging, adjuvant treatment, and follow-up. The aim of this study is to gain an overview about management strategies of high-volume German neurosurgical departments treating these patients.

Material and Methods: A questionnaire including diagnostic, preoperative, perioperative, and postoperative parameters and 5 cases with magnetic resonance imaging data with questions to various treatment options in these patients was sent to all 34 German neurosurgical departments at university hospitals.

Results: In total, 24 questionnaires were returned and analysed. Centres were divided into those who generally practice a “wait-and-see” strategy vs. those who do not or only in highly selected cases. Statistical analyses were performed with Fisher test and Chi²-test. Interestingly, 50% of all centres routinely follow a “wait-and-see” strategy.

Conclusion: Although the management of patients with LGG is complex and a simple questionnaire will not be able to define a standard in diagnosis and treatment, this study offers an overview on strategies at high-volume academic centres dealing with these patients. There is consensus to resect superficially located lobar and circumscribed low-grade lesions. However, the differences between centres become apparent with increasing complexity of the lesions.

Key words

low-grade glioma - survey - treatment

References

• 1 Albert FK, Forsting M, Sartor K. et al . Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis.  Neurosurgery. 1994;  34 45-60
• 2 Brada M, Viviers L, Abson C. et al . Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas.  Ann Oncol. 2003;  14 1715-1721
• 3 DeAngelis LM. Brain tumors.  N Engl J Med. 2001;  344 114-123
• 4 Douw L, Klein M, Fagel SS. et al . Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up.  Lancet Neurol. 2009;  8 810-818
• 5 Duffau H, Lopes M, Arthuis F. et al . Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution.  J Neurol Neurosurg Psychiatry. 2005;  76 845-851
• 6 Forsting M, Albert FK, Kunze S. et al . Extirpation of glioblastomas: MR and CT follow-up of residual tumor and regrowth patterns.  AJNR. 1993;  14 77-87
• 7 Ginsberg LE, Fuller GN, Hashmi M. et al . The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series.  Surg Neurol. 1998;  49 436-440
• 8 Hoang-Xuan K, Capelle L, Kujas M. et al . Temozolomide as initial treatment for adults with lowgrade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions.  J Clin Oncol. 2004;  22 3133-3138
• 9 Janny P, Cure H, Mohr M. et al . Low grade supratentorial astrocytomas. Management and prognostic factors.  Cancer. 1994;  73 1937-1945
• 10 Kaloshi G, Benouaich-Amiel A, Diakite F. et al . Temozolomide for low-grade gliomas: predictive impact of 1p/19q loss on response and outcome.  Neurology. 2007;  68 1831-1836
• 11 Karim AB, Maat B, Hatlevoll R. et al . A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844.  Int J Radiat Oncol Biol Phys. 1996;  36 549-556
• 12 Keles GE, Lamborn KR, Berger MS. Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome.  J Neurosurg. 2001;  95 735-745
• 13 Korinth MC. Low-dose aspirin before intracranial surgery–results of a survey among neurosurgeons in Germany.  Acta Neurochir. 2006;  148 1189-1196
• 14 Korinth MC, Gilsbach JM, Weinzierl MR. Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany.  Eur Spine J. 2007;  16 365-372
• 15 Lehnhardt FG, Bock C, Roehn G. et al . Metabolic differences between primary and recurrent human brain tumors: a 1 H NMR spectroscopic investigation.  NMR Biomed. 2005;  18 371-382
• 16 Louis DN, Ohgaki H, Wiestler OD. et al .(eds.) WHO Classification of Tumours of the Central Nervous System.. IARC: Lyon; 2007
• 17 McGirt MJ, Chaichana KL, Attenello FJ. et al . Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas.  Neurosurgery. 2008;  63 700-707
• 18 Pauleit D, Stoffels G, Bachofner A. et al . Comparison of (18)F-FET and (18)F-FDG PET in brain tumors.  Nucl Med Biol. 2009;  36 779-787
• 19 Philippon JH, Clemenceau SH, Fauchon FH. et al . Supratentorial low-grade astrocytomas in adults.  Neurosurgery. 1993;  32 554-559
• 20 Pöpperl G, Kreth FW, Herms J. et al . Analysis of ¹⁸F-FET PET for grading of recurrent gliomas: is evaluation of uptake kinetics superior to standard methods?.  J Nucl Med. 2006;  47 393-403
• 21 Pouratian N, Mut M, Jagannathan J. et al . Low-grade gliomas in older patients: a retrospective analysis of prognostic factors.  J Neurooncol. 2008;  90 341-350
• 22 Pouratian N, Schiff D. Management of Low-grade glioma.  Curr Neurol Neurosci Rep. 2010;  10 224-231
• 23 Recht LD, Lew R, Smith TW. Suspected low-grade glioma: is deferring treatment safe?.  Ann Neurol. 1992;  31 431-436
• 24 Reijneveld JC, Sitskoorn MM, Klein M. et al . Cognitive status and quality of life in patients with suspected versus proven low-grade gliomas.  Neurology. 56 618-623
• 25 Sakowitz OW, Raabe A, Vucak D. et al . Contemporary management of aneurysmal subarachnoid hemorrhage in Germany: results of a survey among 100 neurosurgical departments.  Neurosurgery. 2006;  58 137-145
• 26 Seiz M, Dimitrakopoulou-Strauss A, Schubert GA. et al . Differentiation between malignant transformation and tumour recurrence by (68)Ga-bombesin and (18)F-FDG-PET, in patients with low grade gliomas.  Hell J Nucl Med. 2008;  11 149-152
• 27 Schaffranietz L, Grothe A, Olthoff D. Use of the sitting position in neurosurgery. Results of a 1998 survey in Germany.  Anaesthesist. 2000;  49 269-274
• 28 Shaw EG, Tatter SB, Lesser GJ. et al . Current controversies in the radiotherapeutic management of adult low-grade glioma.  Semin Oncol. 2004;  31 653-658
• 29 Smith JS, Chang EF, Lamborn KR. et al . Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas.  J Clin Oncol. 2008;  26 1338-1345
• 30 van den Bent MJ, Afra D, de Witte O. et al . Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial.  Lancet. 2005;  366 985-990
• 31 Wessels PH, ter Berg JW, Spincemaille GH. et al . Treatment of cerebellar hematoma in The Netherlands. A questionnaire survey.  Cerebrovasc Dis. 2001;  11 190-194

Correspondence