Molecular features and clinical outcomes in surgically treated low-grade diffuse gliomas in patients over the age of 60

Ramin A. Morshed, Seunggu (Jude) Han, Shawn L. Hervey-Jumper, Melike Pekmezci, Irene Troncon, Susan M. Chang, Nicholas A. Butowski, Mitchel S. Berger

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: WHO grade II gliomas are uncommon in patients over the age of 60, and there is a lack in consensus regarding their management. We present molecular tumor characteristics as well as clinical outcomes in patients over the age of 60 undergoing surgical resection of a WHO grade II glioma. Methods: After receiving IRB approval, patients were identified through the UCSF Brain Tumor Center. Pathologic diagnosis was completed using WHO 2016 grading criteria. Results: Twenty-six patients with a mean age of 66 years met inclusion criteria with a median follow-up of 5.2 years. Diagnoses included diffuse astrocytoma IDH-mutant (19.2%), diffuse astrocytoma IDH-wildtype (26.9%), Oligodendroglioma IDH-mutant and 1p/19q-codeleted (50%), and a rare case of mixed oligoastrocytoma (3.9%). 66% of astrocytoma IDH-wildtype tumors possessed TERT mutation. Median extent of resection was 75.4%. Progression-free (PFS) and overall survival (OS) were 23.5 and 62.6 months, respectively. Shorter PFS was associated with the astrocytoma IDH-wildtype subtype despite similar extent of resection and adjuvant treatment rates compared to the other subtypes. OS did not differ between subtypes. Malignant transformation and death were associated with larger preoperative and residual tumor volume. Conclusions: Older patients with diffuse gliomas may safely undergo aggressive treatment with surgical resection and adjuvant therapy. Elderly patients with low grade gliomas have worse clinical outcomes compared to their younger counterparts. This may be due to an increased frequency of diffuse astrocytoma IDH-wildtype tumors in this age group.

Original languageEnglish (US)
Pages (from-to)383-391
Number of pages9
JournalJournal of Neuro-Oncology
Volume141
Issue number2
DOIs
StatePublished - Jan 30 2019

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Astrocytoma
Glioma
Oligodendroglioma
Neoplasms
Residual Volume
Survival
Research Ethics Committees
Residual Neoplasm
Tumor Burden
Brain Neoplasms
Therapeutics
Age Groups
Mutation

Keywords

  • Elderly
  • Low-grade glioma
  • Old age
  • Surgical resection

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Molecular features and clinical outcomes in surgically treated low-grade diffuse gliomas in patients over the age of 60. / Morshed, Ramin A.; Han, Seunggu (Jude); Hervey-Jumper, Shawn L.; Pekmezci, Melike; Troncon, Irene; Chang, Susan M.; Butowski, Nicholas A.; Berger, Mitchel S.

In: Journal of Neuro-Oncology, Vol. 141, No. 2, 30.01.2019, p. 383-391.

Research output: Contribution to journalArticle

Morshed, RA, Han, SJ, Hervey-Jumper, SL, Pekmezci, M, Troncon, I, Chang, SM, Butowski, NA & Berger, MS 2019, 'Molecular features and clinical outcomes in surgically treated low-grade diffuse gliomas in patients over the age of 60', Journal of Neuro-Oncology, vol. 141, no. 2, pp. 383-391. https://doi.org/10.1007/s11060-018-03044-4
Morshed, Ramin A. ; Han, Seunggu (Jude) ; Hervey-Jumper, Shawn L. ; Pekmezci, Melike ; Troncon, Irene ; Chang, Susan M. ; Butowski, Nicholas A. ; Berger, Mitchel S. / Molecular features and clinical outcomes in surgically treated low-grade diffuse gliomas in patients over the age of 60. In: Journal of Neuro-Oncology. 2019 ; Vol. 141, No. 2. pp. 383-391.
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AU - Han, Seunggu (Jude)

AU - Hervey-Jumper, Shawn L.

AU - Pekmezci, Melike

AU - Troncon, Irene

AU - Chang, Susan M.

AU - Butowski, Nicholas A.

AU - Berger, Mitchel S.

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N2 - Purpose: WHO grade II gliomas are uncommon in patients over the age of 60, and there is a lack in consensus regarding their management. We present molecular tumor characteristics as well as clinical outcomes in patients over the age of 60 undergoing surgical resection of a WHO grade II glioma. Methods: After receiving IRB approval, patients were identified through the UCSF Brain Tumor Center. Pathologic diagnosis was completed using WHO 2016 grading criteria. Results: Twenty-six patients with a mean age of 66 years met inclusion criteria with a median follow-up of 5.2 years. Diagnoses included diffuse astrocytoma IDH-mutant (19.2%), diffuse astrocytoma IDH-wildtype (26.9%), Oligodendroglioma IDH-mutant and 1p/19q-codeleted (50%), and a rare case of mixed oligoastrocytoma (3.9%). 66% of astrocytoma IDH-wildtype tumors possessed TERT mutation. Median extent of resection was 75.4%. Progression-free (PFS) and overall survival (OS) were 23.5 and 62.6 months, respectively. Shorter PFS was associated with the astrocytoma IDH-wildtype subtype despite similar extent of resection and adjuvant treatment rates compared to the other subtypes. OS did not differ between subtypes. Malignant transformation and death were associated with larger preoperative and residual tumor volume. Conclusions: Older patients with diffuse gliomas may safely undergo aggressive treatment with surgical resection and adjuvant therapy. Elderly patients with low grade gliomas have worse clinical outcomes compared to their younger counterparts. This may be due to an increased frequency of diffuse astrocytoma IDH-wildtype tumors in this age group.

AB - Purpose: WHO grade II gliomas are uncommon in patients over the age of 60, and there is a lack in consensus regarding their management. We present molecular tumor characteristics as well as clinical outcomes in patients over the age of 60 undergoing surgical resection of a WHO grade II glioma. Methods: After receiving IRB approval, patients were identified through the UCSF Brain Tumor Center. Pathologic diagnosis was completed using WHO 2016 grading criteria. Results: Twenty-six patients with a mean age of 66 years met inclusion criteria with a median follow-up of 5.2 years. Diagnoses included diffuse astrocytoma IDH-mutant (19.2%), diffuse astrocytoma IDH-wildtype (26.9%), Oligodendroglioma IDH-mutant and 1p/19q-codeleted (50%), and a rare case of mixed oligoastrocytoma (3.9%). 66% of astrocytoma IDH-wildtype tumors possessed TERT mutation. Median extent of resection was 75.4%. Progression-free (PFS) and overall survival (OS) were 23.5 and 62.6 months, respectively. Shorter PFS was associated with the astrocytoma IDH-wildtype subtype despite similar extent of resection and adjuvant treatment rates compared to the other subtypes. OS did not differ between subtypes. Malignant transformation and death were associated with larger preoperative and residual tumor volume. Conclusions: Older patients with diffuse gliomas may safely undergo aggressive treatment with surgical resection and adjuvant therapy. Elderly patients with low grade gliomas have worse clinical outcomes compared to their younger counterparts. This may be due to an increased frequency of diffuse astrocytoma IDH-wildtype tumors in this age group.

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