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

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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.

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Acknowledgements

We would like to thank Jing Li for completing the search of the institutional database for patients qualifying for this study.

Author information

Author notes

  1. Ramin A. Morshed and Seunggu J. Han contributed equally to this work.

Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    Ramin A. Morshed, Shawn L. Hervey-Jumper, Melike Pekmezci, Irene Troncon, Susan M. Chang, Nicholas A. Butowski & Mitchel S. Berger

  2. Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA

    Seunggu J. Han

  3. Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave., Rm. M-779, San Francisco, CA, 94143-0112, USA

    Mitchel S. Berger

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  1. Ramin A. Morshed
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All authors have contributed significantly to the experimental design, analyses, interpretation of the data and writing of the manuscript.

Corresponding author

Correspondence to Mitchel S. Berger.

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The authors declare that they have no conflict of interest.

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Morshed, R.A., Han, S.J., Hervey-Jumper, S.L. et al. Molecular features and clinical outcomes in surgically treated low-grade diffuse gliomas in patients over the age of 60. J Neurooncol 141, 383–391 (2019). https://doi.org/10.1007/s11060-018-03044-4

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  • DOI: https://doi.org/10.1007/s11060-018-03044-4

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