title: Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial.
abstract: BACKGROUND
  Postoperative policies of "wait-and-see" and radiotherapy for low-grade glioma are poorly defined. A trial in the mid 1980s established the radiation dose. In 1986 the EORTC Radiotherapy and Brain Tumor Groups initiated a prospective trial to compare early radiotherapy with delayed radiotherapy. An interim analysis has been reported. We now present the long-term results.
  
  
  METHODS
  After surgery, patients from 24 centres across Europe were randomly assigned to either early radiotherapy of 54 Gy in fractions of 1.8 Gy or deferred radiotherapy until the time of progression (control group). Patients with low-grade astrocytoma, oligodendroglioma, mixed oligoastrocytoma, and incompletely resected pilocytic astrocytoma, with a WHO performance status 0-2 were eligible. Analysis was by intention to treat, and primary endpoints were overall and progression-free survival.
  
  
  RESULTS
  157 patients were assigned early radiotherapy, and 157 control. Median progression-free survival was 5.3 years in the early radiotherapy group and 3.4 years in the control group (hazard ratio 0.59, 95% CI 0.45-0.77; p<0.0001). However, overall survival was similar between groups: median survival in the radiotherapy group was 7.4 years compared with 7.2 years in the control group (hazard ratio 0.97, 95% CI 0.71-1.34; p=0.872). In the control group, 65% of patients received radiotherapy at progression. At 1 year, seizures were better controlled in the early radiotherapy group.
  
  
  CONCLUSIONS
  Early radiotherapy after surgery lengthens the period without progression but does not affect overall survival. Because quality of life was not studied, it is not known whether time to progression reflects clinical deterioration. Radiotherapy could be deferred for patients with low-grade glioma who are in a good condition, provided they are carefully monitored.
authors.affiliation: Erasmus Medical Centrum Daniel den Hoed Oncology Center, Rotterdam. m.vandenbent@erasmusmc.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: van den Bent
authors.forename: D
authors.initials: D
authors.lastname: Afra
authors.forename: O
authors.initials: O
authors.lastname: de Witte
authors.forename: M
authors.initials: M
authors.lastname: Ben Hassel
authors.forename: S
authors.initials: S
authors.lastname: Schraub
authors.forename: K
authors.initials: K
authors.lastname: Hoang-Xuan
authors.forename: P-O
authors.initials: PO
authors.lastname: Malmström
authors.forename: L
authors.initials: L
authors.lastname: Collette
authors.forename: M
authors.initials: M
authors.lastname: Piérart
authors.forename: R
authors.initials: R
authors.lastname: Mirimanoff
authors.forename: A B M F
authors.initials: AB
authors.lastname: Karim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000401:mortality / Q000532:radiotherapy*; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009837:Oligodendroglioma / Q000401:mortality / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D015996:Survival Rate