Abstract
Purpose
Adjuvant radiation is often used in patients with low grade gliomas with high-risk characteristics with a recommended dose of 45–54 Gy. We used the National Cancer Database (NCDB) to see which doses were being used, and if any difference was seen in outcome.
Methods
We queried the NCDB for patients with WHO Grade 2 primary brain tumors treated with surgery and adjuvant radiotherapy. We divided the cohort into dose groups: 45–50 Gy, 50.4–54 Gy, and > 54 Gy. Multivariable logistic regression was used to identify predictors of low and high dose radiation. Propensity matching was used to account for indication bias.
Results
We identified 1437 patients meeting inclusion criteria. Median age was 45 years and 62% of patients were > 40 years old. Nearly half of patients (48%) had astrocytoma subtype and 70% had subtotal resection. The majority of patients (69%) were treated to doses between 50.4 and 54 Gy. Predictors of high dose radiation (> 54 Gy) were increased income, astrocytoma subtype, chemotherapy receipt, and treatment in later year (2014). The main predictors of survival were age > 40, astrocytoma subtype, and insurance type. Patients treated to a dose of > 54 Gy had a median survival of 73.5 months and was not reached in those treated to a lower dose (p = 0.0041).
Conclusions
This analysis shows that 50.4–54 Gy is the most widely used radiation regimen for the adjuvant treatment of low-grade gliomas. There appeared to be no benefit to higher doses, although unreported factors may impact interpretation of the results.
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Data availability
Data was acquired from the NCDB. Data is not available because we do not have access/ability to share NCDB data.
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REW and SA contributed to the study conception, design, material preparation, data collection and analysis. The first draft of the manuscript was written by EB and all authors edited and commented on previous versions of the manuscript. All authors approved the final manuscript.
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Byrne, E., Abel, S., Yu, A. et al. Trends in radiation dose for low grade gliomas across the United States. J Neurooncol 157, 197–205 (2022). https://doi.org/10.1007/s11060-022-03962-4
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DOI: https://doi.org/10.1007/s11060-022-03962-4