title: On the issue of early and aggressive treatment in grade 2 gliomas.
abstract: OBJECTIVE
  To study the effects of surgery and timing of radiotherapy on patient survival in grade 2 gliomas.
  
  
  METHODS
  One hundred and eighty-nine patients with diffuse astrocytomas, oligoastrocytomas, and oligodendrogliomas, World Health Organization grade 2, treated between 1982 and 2000 were identified. The impact of treatment given and clinical parameters were studied in univariate- and multivariate survival analyses.
  
  
  RESULTS
  Median survival for the whole patient sample was 6.4 years and the 5-year survival rate was 60%. Macroscopic total resection was beneficial in the univariate analysis (P=0.03) but not when adjusting for confounders. Early subtotal resection did not prolong survival. Early radiotherapy was associated with a shorter survival time compared to delayed or no irradiation (P=0.004). However, this difference was mainly due to an unequal distribution of prognostic factors and was not significant in the multivariate analysis. The most important predictors for long survival time were young age ( P<0.001), oligodendroglioma histology ( P<0.001), and small tumour size ( P=0.02).
  
  
  CONCLUSIONS
  Early conventional treatment with surgery and radiotherapy had no positive effect on patient survival. This opens up the possibility of trying and evaluating other first-line treatment regimens in this disease.
authors.affiliation: Department of Neuroscience, University Hospital, 751 85 Uppsala, Sweden. dan.ribom@neurologi.uu.se
authors.forename: Dan
authors.initials: D
authors.lastname: Ribom
authors.forename: Anja
authors.initials: A
authors.lastname: Smits
authors.forename: Magdalena
authors.initials: M
authors.lastname: Hartman
authors.forename: Lennart
authors.initials: L
authors.lastname: Persson
authors.forename: Erik
authors.initials: E
authors.lastname: Blomquist
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014944:World Health Organization