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Oligodendroglioma confers higher risk of radiation necrosis

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Abstract

Background

Radiation therapy (RT) remains a mainstay for the treatment of lower grade gliomas. Radiation neurotoxicity is a serious complication, carrying high morbidity in the absence of tumor progression. The incidence remains poorly categorized and known risk factors identified are related to the radiation modality. We hypothesized that patients with oligodendroglioma have a higher risk of radiation necrosis (RN) as compared to patients with astrocytoma.

Methods

We conducted a retrospective review of adults with lower grade diffuse gliomas over a 10-year span. The primary outcome was RN, either pathologically confirmed or clinically diagnosed. Cases without pathological confirmation must have been symptomatic, requiring administration of bevacizumab or high-dose steroids. Cox proportional hazard ratios were used for multivariate analyses.

Results

In 319 patients, we identified RN in 41 patients (12.9%): 28 patients (21.3%) with oligodendroglioma and 13 (6.9%) with astrocytoma (HR 3.42, p < 0.001). Patients with oligodendroglioma who received > 54 Gy had a higher incidence (31.2%) than those receiving ≤ 54 Gy (14.3%, HR 6.9, p = 0.002). There was no similar correlation among patients with astrocytoma. There was no difference in incidence based on use of concomitant temozolomide. Radiation necrosis appeared within 24 months from radiation in 80.5% of patients.

Conclusion

Our study suggests that patients with oligodendroglioma are at higher risk of developing RN. The incidence increases with increasing radiation dose in patients with oligodendroglioma but not with astrocytoma. RN usually appears within 24 months from RT. Patients with oligodendroglioma receiving > 54 Gy are at highest risk.

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Funding

SHP was funded by a Radiological Society of North America Research Scholar Grant (RSCH1819). The other authors have no funding to report.

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Authors and Affiliations

  1. Department of Neurology, Division of Neuro-Oncology, University of Virginia Health System, P.O. Box 800432, Charlottesville, VA, 22908, USA

    Haroon Ahmad, Benjamin Purow, David Schiff & Camilo E. Fadul

  2. Claude Moore Health Sciences Library, University of Virginia Health System, Charlottesville, VA, USA

    David Martin

  3. Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia Health System, Charlottesville, VA, USA

    Sohil H. Patel & Joseph Donahue

  4. Department of Pathology, Divisions of Neuropathology, University of Virginia Health System, Charlottesville, VA, USA

    Beatriz Lopes

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  1. Haroon Ahmad
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  2. David Martin
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Contributions

Primary author, data collection, Analysis: H Ahmad, MD. Statistical analysis and figures: D Martin, MSc. Radiographic analysis and review: SH Patel, MD. Radiographic analysis and review: J Donahue, MD. Pathologic analysis and review: B Lopes, MD. Review and editing: B Purow, MD. Review and editing: D Schiff, MD. Senior author, analysis, review: CE Fadul, MD.

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Correspondence to Camilo E. Fadul.

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Ahmad, H., Martin, D., Patel, S.H. et al. Oligodendroglioma confers higher risk of radiation necrosis. J Neurooncol 145, 309–319 (2019). https://doi.org/10.1007/s11060-019-03297-7

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