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Effect of neoadjuvant temozolomide upon volume reduction and resection of diffuse low-grade glioma

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Abstract

Maximal safe resection is associated with prolonged survival in patients with low-grade glioma (LGG). It has been suggested that neoadjuvant temozolomide may provide sufficient tumor shrinkage to facilitate aggressive surgical debulking. We examined the impact of temozolomide upon volume reduction and resectability of LGG. We retrospectively identified 20 adult patients with biopsy-proven, deemed not totally resectable LGGs, treated initially with temozolomide. Volumetric 3D (calculated from serial FLAIR images) and 2D tumor measurements were obtained prior to treatment and at 3 months post-treatment. The anticipated extent of resection (EOR) at the 2 time points was measured based on anatomical limitations, calculated as: [(total tumor volume – unresectable tumor volume)/total tumor volume] ×100. Eloquent cortex, deep structures and corpus callosum were considered unresectable. Mean tumor volume was 68.4 cm3 pre-treatment and 49.5 cm3 at 3 months post-treatment. The mean change from baseline to 3 months after treatment was −32.5 % (p < 0.001). Mean 2D pre-treatment area was 28.6 and 23.3 cm2 at 3 months post-treatment. The 2D change was also significant, with mean change of −17 % (p < 0.001). 5 % had partial response; 40 % minor response; 45 % stable disease; and 10 % progressive disease by RANO criteria. Mean pre-treatment anticipated EOR was 67.2 and 71.5 % at 3 months post-treatment. The mean change from baseline was 4.3 % (p = 0.10). Our findings demonstrate significant volumetric and 2D reduction of LGG with temozolomide. Although this tumor shrinkage might facilitate radical surgical resection in some cases, our data failed to show statistically significant improvement in anticipated EOR.

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The authors declare they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neuro-Oncology, Department of Neurology, University of Virginia, Hospital West Room 6225, PO Box 800432, Charlottesville, VA, 22908, USA

    Jasmin Jo & David Schiff

  2. Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA

    Brian Williams, Mark E. Shaffrey & David Schiff

  3. Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, 22908, USA

    Mark Smolkin

  4. Division of Neuroradiology, Department of Radiology, University of Virginia, Charlottesville, VA, 22908, USA

    Max Wintermark

  5. Division of Neuropathology, Department of Pathology, University of Virginia, Charlottesville, VA, 22908, USA

    M. Beatriz Lopes

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  1. Jasmin Jo
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Correspondence to David Schiff.

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Jo, J., Williams, B., Smolkin, M. et al. Effect of neoadjuvant temozolomide upon volume reduction and resection of diffuse low-grade glioma. J Neurooncol 120, 155–161 (2014). https://doi.org/10.1007/s11060-014-1538-7

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  • DOI: https://doi.org/10.1007/s11060-014-1538-7

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