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Radio-chemotherapy improves survival in IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma patients

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Abstract

Isocitrate dehydrogenase (IDH) mutations are beginning to drive decisions on therapy for glioma patients. Here we sought to determine the impact of adjuvant treatment in patients with IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma (sHGA) WHO grades III/IV. Clinical data of 109 sHGA patients grades III/IV, in addition to IDH mutation-, 1p/19q-codeletion- and MGMT-promoter methylation status—were retrospectively analyzed. Survival analysis in relation to adjuvant treatment modalities and molecular profiling were performed. Out of 109 patients, 88 patients (80.7 %) harbored IDH mutations, 30 patients had a 1p/19q-codeletion (27.5 %) and 69 patients (63.3 %) exhibited a methylated MGMT-promoter status. At a median follow-up of 9.8 years, 62 patients (57 %) died. The postsurgical treatment included: radio-chemotherapy (RT-CT; 54.5 %), RT alone (19.3 %), and CT alone (22.7 %). The median overall survival (OS) in the entire group was 3.4 years (1.9–6.7 years). Patients who received RT-CT had a significantly longer OS compared with those who underwent RT alone (6.5 vs. 1.2 years, HR 0.35, CI 0.32–0.51, p = 0.011). In the IDH-mutant 1p/19q non-codeleted sHGA subgroup the RT-CT cohort had a significantly longer OS in comparison to the RT cohort (6.4 vs. 1.2 years, HR 2.7, CI 1.1–6.5, p = 0.022). In the stepwise multivariable Cox model for OS of all 88 IDH-mutant sHGA patients, survival was strongly associated with only one factor, namely, adjuvant RT-CT at diagnosis of a sHGA. This retrospective long-term study demonstrates that RT and CT (mostly PCV) significantly improves progression-free and overall survival in IDH-mutant secondary high-grade astrocytoma patients, regardless of 1p/19q-codeletion status.

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Acknowledgments

The authors thank sincerely Mrs. Silke Soucek for her support by the statistical analyses. The study was presented at the 19th Annual scientific meeting of the Society for Neuro-Oncology in Miami.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The authors did not receive any funding that support this work.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany

    Tareq A. Juratli, Thomas Pinzer, Gabriele Schackert & Dietmar Krex

  2. Department of Radiation Oncology, Ohio State University Comprehensive Cancer Center/Arthur G. James Cancer Hospital and Richard L. Solove Research Institute, The Ohio State University College of Medicine, Columbus, OH, USA

    Tim Lautenschläger

  3. Institute of Neuropathology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Kathrin D. Geiger

  4. German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany

    Mechthild Krause & Dietmar Krex

  5. Institute of Radiooncology, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany

    Mechthild Krause

  6. Department of Radiation Oncology and OncoRay, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Mechthild Krause

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  1. Tareq A. Juratli
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  2. Tim Lautenschläger
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  3. Kathrin D. Geiger
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Corresponding author

Correspondence to Tareq A. Juratli.

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Supplementary Fig. 1: The life table curve showed a significantly prolonged median progression free survival in the radio-chemotherapy cohort (RT-CT) in comparison with the radiotherapy (RT) group (3.4 vs. 0.9 years). p = 0.007 (Wilcoxon-Test).

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Juratli, T.A., Lautenschläger, T., Geiger, K.D. et al. Radio-chemotherapy improves survival in IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma patients. J Neurooncol 124, 197–205 (2015). https://doi.org/10.1007/s11060-015-1822-1

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  • DOI: https://doi.org/10.1007/s11060-015-1822-1

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