medigraphic.com
Instituto Nacional de Neurología y Neurocirugía

2008, Number 1

<< Back Next >>

Arch Neurocien 2008; 13 (1)

Supratentorial low grade astrocytoma in the adult: therapeutic options

Prat AR, Galeano SI

Language: Spanish
References: 72
Page: 35-42
PDF size: 83.55 Kb.


ABSTRACT

Introduction: supratentorial low grade astrocytoma in the adult requires multidisciplinary treatment. Our revision analizes the role of radiotherapy, surgery and chemotherapy in its treatment and defines their timing. Discussion: posible use of chemotherapy as first alternative after surgery of supratentorial low grade astrocytomas is analized. Efficacy of temozolomide is compared with other chemoterapy modalities. Surgery, including biopsy alone, citorreductive surgery or radical surgery still plays a fundamental role in these tumors treatment. Early surgery versus delayed surgery and their pros and cons are analized as well as the degree of resection and their overall impact on outcome. The role of conventional and interstitial radiotherapy is studied, including early radiotherapy after surgery or after recurrence of the tumor. Side efects of radiotherapy are included in the revision focusing on its limitations. The multidisciplinary approach is explained, studying the combined use of the three therapeutic options, analizing their influence on outcome, their use in different groups of patients, timing and limitations of thur use. Conclusions: survival rate of adult patients presenting supratentorial low grade astrocytoma increases in selected patients who may benefit from the combined use of chemotherapy, surgery and radiotherapy.


REFERENCES

  1. Perry A. Pathology of low-grade gliomas: an update of emerging concepts. Neuro-oncology 2003; 5: 168-78.

  2. Shaw EG, Daumas-Duport C, Scheithauer BW, Gilbertson DT, O’Fallon JR, et al. Radiation therapy in the management of lowgrade supratentorial astrocytomas. J Neurosurg 1989; 70: 853-61.

  3. Karim AB, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O, et al. Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis. Int J Radiat Oncol Biol Phys 2002; 52: 316-24.

  4. Karim AB, Maat B, Hatlevoll R, Menten J, Rutten EH, Thomas DG, 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: 549-56.

  5. Shaw E, Arusell R, Scheithauer B, O’Fallon J, O’Neill B, Dinapoli R, et al. Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: Initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group Study. J Clin Oncol 2002; 20: 2267-76.

  6. Kreth FW, Faist M, Warnke PC, Rossner R, Volk B, Ostertag CB. Interstitial radiosurgery of low-grade gliomas. J Neurosurg 1995; 82: 418-29.

  7. Kreth FW, Faist M, Rossner R, Volk B, Ostertag CB. Supratentorial World Health Organization grade 2 astrocytomas and oligoastrocytomas. A new pattern of prognostic factors. Cancer 1997; 79: 370-9.

  8. Johannesen TB, Langmark F, Lote K. Progress in long-term survival in adult patients with supratentorial low-grade gliomas: a population-based study of 993 patients in whom patients were diagnosed between 1970-1993. J Neurosurg 2003; 99: 854-62.

  9. Scerrati M, Roselli R, Iacoangeli M, Pompucci A, Rossi GF. Prognostic factors in low grade (WHO Grade 2) gliomas of the cerebral hemispheres: the role of surgery. J Neurol Neurosurg Psychiatry 1996; 61: 291-6.

  10. Lote K, Egeland T, Hager B, Stenwig B, Skullerund K, Berg-Johnsen J, et al. Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 1997; 15: 3129-40.

  11. Leighton C, Fisher B, Bauman G, Depiero S, Stitt L, MacDonald D, et al. Supratentorial lowgrade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 1997; 15: 1294-301.

  12. Morantz RA. The management of the patient with a low-grade cerebral astrocytoma. In Morantz RA, Walsh JW, eds. Brain tumors. New York: Marcel Dekker; 1994. 387-415.

  13. Touboul E, Schlienger M, Buffat L, Balosso J, Minne JF, et al. Radiation therapy with or without surgery in the management of low-grade brain astrocytomas. A retrospective study of 120 patients. Bull Cancer Radiother 1995; 82: 388-95.

  14. Friston KJ, Frith CD, Liddle PF, Frackowiak RS. Comparing functional (PET).

  15. North CA, North RB, Epstein JA, Piantadosi S, Wharam MD. Low-grade cerebral astrocytomas. Survival and quality of life alter radiation therapy. Cancer 1990; 66:6-14.

  16. Cairncross G, Macdonald D, Ludwin S, Lee D, Cascino T, Buckner J, et al. Chemotherapy for anaplastic oligodendroglioma. J Clin Oncol 1994; 12: 2013-21.

  17. Glass J, Hochberg FH, Gruber ML. The treatment of oligodendrogliomas and mixed oligodendroglioma astrocytomas and PCV chemotherapy. J Neurosurg 1992; 76:741-5.

  18. Peterson K, Paleologos N, Forsyth P, Macdonald DR, Cairncross JG. Salvage chemotherapy for oligodendroglioma. J Neurosurg 1996; 85: 597-601.

  19. Mason W, Krol G, DeAnglelis L. Low-grade oligodendroglioma responds to chemotherapy. Neurology 1996; 46: 203-7.

  20. Yung W, Prados M, Yaya-Tur R, Rosenfeld SS, Brada M, Friedman HS, et al. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. J Clin Oncol 1999; 17: 2762-71.

  21. Yung WK, Albright RE, Olson J, Fredericks R, Fink K, Prados MD, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 2000; 83: 588-93.

  22. Brada M, Hoang-Xuan K, Rampling R. Multicenter phase II trial of Temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol 2001; 12: 259-66.

  23. Rajan B, Ross G, Lim CC, Ashley S, Goode D, Triash D et al. Survival in patients with recurrent glioma as a measure of treatment efficacy: prognostic factors following nitrosourea chemotherapy. Eur J Cancer 1994; 12: 1809-15.

  24. Brada M ,Viviers L, Abson C, Hines F , Britton J, Ashley S et al. Phase II study of primary temozolomide chemotherapy in patients with WHO grade II gliomas. Annals of Oncology 2003; 14: 1715-21.

  25. Eyre HJ, Crowley JJ, Townsend JJ, Eltringham JR, Morantz RA, Schulman SF, et al. A randomized trial of radio-therapy versus radiotherapy plus CCNU for incompletely resected lowgrade gliomas: a Southwest Oncology Group study. J Neurosurg 1993; 78: 909-14.

  26. Olson JD, Riedel E, DeAngelis LM. Long-term outcome of lowgrade oligodendroglioma and mixed glioma. Neurology 2000; 54: 1442-8.

  27. Quinn JA, Reardon DA, Friedman AH, Rich .1-N, Sampson JH, Provenzale JM et al. Phase II trial of temozolomide in patients with progressive low-grade glioma. J Clin Oncol 2003; 21: 646-51.

  28. Pace A, Vidiri A, Galié E, Carosi M, Telera S, Cianciulli AM, et al. Temozolomide chemotherapy for progressive low grade glioma: clinical benefits and radiological response. Ann Oncol 2003; 14: 1722-6.

  29. Soffietti R, Ruda R, Borgognone M, Schiffer D. Chemotherapy with PCV for low grade nonenhancing oligodendrogliomas and oligoastrocytomas. Neurology 1999; 52: A423-4 (abstr).

  30. Buckner JC, Gesme D, O’Fallon JR, Hammack JE, Stafford S, Brown PD, et al. Phase II trial of procarbazine, lomustine, and vincristine as initial therapy for patients with low grade oligodendroglioma or oligoastrocytoma: efficacy and associations with chromosomal abnormalities. J Clin Oncol 2003; 21: 251-5.

  31. Hoang-Xuan K, Capelle L, Kujas M, Taillibert S, Duffau H, Lejeune J, et al. Temozolomide as initial treatment for adults with lowgrade oligodendrogliomas or oligoastrocytomas and correlation with chromosome lp deletions. J Clin Oncol 2004; 22: 3133-8.

  32. Laws ER, Taylor WF, Clifton MB, Okazaki H. Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 1984; 61: 665-73.

  33. Soffietti R, Chio A, Giordana MT, Vasario E, Schiffer D. Prognostic factors in well differentiated cerebral astrocytomas in the adult. Neurosurgery 1989; 24: 686-92.

  34. Medbery CA, Straus KL, Steinberg SM, Cotelingam JD, Fisher WS. Low-grade astrocytomas: treatment results and prognostic variables. Int J Radiat Oncol Biol Phys 1988; 15: 837-41.

  35. Piepmeier JM. Observations on the current treatment of lowgrade astrocytic tumors of the cerebral hemispheres. J Neurosurg 1987; 67: 177-81.

  36. Miralbell R, Balart J, Matias-Guiu X, Molet J, Ariza A, Craven- Bartle J. Radiotherapy for supratentorial low-grade gliomas: results and prognostic factors with special focus on tumour volume parameters. Radiother Oncol 1993; 27: 112-6.

  37. Janny P, Cure H, Mohr M, Heldt N, Kwiatkowski F, Lemaire JJ et al. Low grade supratentorial astrocytomas. Management and prognostic factors. Cancer 1994; 73: 1937-45.

  38. Smith DF, Hutton JL, Sandemann D, Foy PM, Shaw MD, Williams IR et al. The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management. J Neurol Neurosurg Psychiatry 1991;54:915-20.

  39. Recht LD, Lew R, Smith TW. Suspected low-grade glioma: is deferring treatment safe? Ann Neurol 1992;31:431-6.

  40. Van Veelen MLC, Avesta CJJ, Kros JM, van Putten W, Vecht Ch . Supratentorial low grade astrocytoma: prognostic factors, differentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry 1998;64:581-7.

  41. Vertosick FT, Selker RG, Arewa VC. Survival of patients with well-differentiated astrocytomas diagnosed in the era of computer tomography. Neurosurgery 1991;28:496-501.

  42. Garcia DM, Fulling KH, Marks JE. The value of radiation therapy in addition to surgery for astrocytomas of the adult cerebrum. Cancer 1985; 55: 919-27.

  43. Fazekas JT. Treatment of grades I and II brain astrocytomas. The role of radiotherapy. Int J Radiat Oncol Biol Phys1977;2: 661-6.

  44. Leibel SA, Sheline GE, Ware WM, Boldrey EB, Nielsen SL. The role of radiation therapy in the treatment of astrocytomas. Cancer 1975; 35: 1551-7.

  45. Walker MD, Alexander E, Hunt WE, Leventhal CM, Mahaley MS Jr, Mealey J, et al. Evaluation of BCNU and/or radiotherapy in treatment of anaplastic gliomas. J Neurosurg 1987; 24: 686-91.

  46. Winger MJ, MacDonald DR, Cairncross JG. Supratentorial anaplastic gliomas in adults: the prognostic importance of the extent of resection and prior low-grade glioma. J Neurosurg 1989;71:487-93.

  47. MRC Brain Tumour Working Party. Prognostic factors for highgrade malignant glioma: development of a prognostic index. J Neuro-oncol 1990; 9: 47-55.

  48. Scott GM, Gibberd FB. Epilepsy and other factors in the prognosis of gliomas. Acta Neurol Scand 1980; 61: 227-39.

  49. Chamberlain MC, Murovic JA, Levin VA. Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 1988; 38: 1371-4.

  50. Shafgat S, Hedley-Whyte ET, Henson JW. Age-dependent rate of anaplastic transformation in low-grade astrocytoma. Neurology 1999; 52: 867-9.

  51. McCormack BM, Miller DC, Budzilovich GN, Voorhees GJ, Ransohoff J. Treatment and survival of low-grade astrocytoma in adults-1977-1988. Neurosurgery 1992; 31: 636-42.

  52. Evans DA, Burbach JP, van Leeuwen FW. Somatic mutations in the brain : relationship to aging? Mutat Res 1995; 338: 173-82.

  53. Holt SE, Shay JW, Wright WE. Refining the telomere-telomerase hypothesis of aging and cancer. Nature Biotech 1996;14:836-9.

  54. Vecht CJ. Effect of age on treatment decisions in low grade glioma. J Neurol Neurosurg Psychiatry 1993; 56: 1256-64.

  55. Roman DD, Sperduto PW. Neuropsychological effects of cranial radiation: current knowledge and future directions. Int J Radiat Oncol Biol Phys 1995; 31: 983-98.

  56. Cairncross JG, Laperriere NJ. Low-grade glioma. To treat or not to treat? Arch Neurol 1989; 46:1238-9.

  57. Shaw EG. Low-grade gliomas: To treat or not to treat? A radiation oncologist’s viewpoint. Arch Neurol 1990; 47: 1138-40.

  58. Kreth FW, Faist M, Rossner R, Birg W, Volk B4Ostertag CB. The risk of interstitial radiotherapy of low-grade gliomas. Radiother Oncol 1997; 43: 253-60.

  59. Kreth FW, Faist M, Grau S, Ostertag CB. Interstitial (125)1 radiosurgery of supratentorial de novo WHO Grade 2 astrocytoma and oligoastrocytoma in adults: long-term results and prognostic factors. Cancer 2006;106:1372-81.

  60. Plathow C, Schulz-Ertner D, Thilman C, Zuna I, Lichy M, Weber MA, et al. Fractionated stereotactic radiotherapy in low-grade astrocytomas: long-term outcome and prognostic factors. Int J Radiat Oncol Biol Phys 2003; 57: 996-1003.

  61. Mehrkens JH, Kreth FW, Muacevic A, Ostertag CB. Long term course of WHO grade 2 astrocytomas of the Insula of Reil after 1-125 interstitial irradiation. J Neurol 2004; 251: 1455-64.

  62. Van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K 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: 985-90.

  63. Osoba D,Brada M,Yung WKA,Prados M. Health-related quality of life in patients treated with temozolomide versus procarbazine for recurrent glioblastoma multiforme. J Clin Oncol 2000; 18:1481-91.

  64. Taphoorn MJ, Schiphorst AK, Snoek FJ, Lindeboom J, Wolbers JG, Karim AB et al. Cognitive functions and quality of life in patients with low-grade gliomas: the impact of radiotherapy. Ann Neurol 1994; 36: 48-54.

  65. Klein M, Heimans JJ, Aaronson NK, et al. Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low grade gliomas: a comparative study. Lancet 2002;360:1361-8.

  66. Brown PD, Buckner JC, O’Fallon JR, Iturria NL, O’Neill BP, Brown CA et al. Effects of radiotherapy on cognitive function in patients with low-grade glioma measured by the folstein mini mental state examination. J Clin Oncol 2003; 21: 2519-24.

  67. Laack N, Brown P. Neurocognitive function after radiotherapy (RT) for supratentorial low-grade gliomas (LGG):results of a North Central Cancer Treatment Group (NCCTG)prospective study. Int J Radiat Oncol Biol Phys 2003; 57: 134 (abstr).

  68. Hanzely Z, Polgar C, Fodor J, Brucher JM, Vitanovics D, Mangel LC, et al. Role of early radiotherapy in the treatment of supratentorial WHO Grade II astrocytomas: long-term results of 97 patients. J Neurooncol 2003; 63: 305-12.

  69. Roberge D, Souhami L, Olivier A, Leblanc R, Podgorsak E. Hypofractionated stereotactic radiotherapy for low grade glioma at McGill University: long-term follow-up. Technol Cancer Res Treat 2006; 5: 1-8.

  70. Heppner PA, Sheehan JP, Steiner LE. Gamma knife surgery for low grade gliomas. Neurosurgery 2005; 57: 1132-9.

  71. Combs SE, Thilmann C, Edler L, Debus J, Schulz-Ertner D. Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol 2005; 23: 8863-9.

  72. Hadjipanayis CG, Kondziolka D, Flickinger JC, Lunsford LD. The role of stereotactic radiosurgery for low-grade astrocytomas. Neurosurg Focus 2003;14:15.




2020     |     www.medigraphic.com