title: Impact of Resection on Survival of Isocitrate Dehydrogenase 1-Mutated World Health Organization Grade II Astrocytoma After Malignant Progression.
abstract: OBJECTIVE
  To evaluate the impact of surgical resection and adjuvant treatment on the course of patients after malignant progression of previously treated isocitrate dehydrogenase 1 (IDH1)-mutated World Health Organization (WHO) grade II astrocytoma.
  
  
  METHODS
  This retrospective study explored 56 patients undergoing tumor resection for malignant progression after previously treated IDH1-mutated WHO grade II astrocytoma. We analyzed survival after malignant progression, analyzed overall survival (OS), and identified prognostic factors using Kaplan-Meier estimates and log-rank test.
  
  
  RESULTS
  By the time of malignant transformation, median age was 44 years, and median Karnofsky Performance Status (KPS) score was 90. Complete resection of contrast-enhancing tissue was achieved in 18 (32.1%) patients. Median survival after re-resection was 33 months (95% confidence interval [CI], 20-46); median OS was 123 months (95% CI, 77-170). Gross total tumor resection, postoperative KPS score ≥80, adjuvant radiochemotherapy, and prior radiotherapy significantly correlated with post-malignant progression survival.
  
  
  CONCLUSIONS
  Patients in good clinical condition with malignant progression of previously treated low-grade gliomas should receive aggressive treatment, including re-resection.
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany. Electronic address: stefan.grau@uk-koeln.de.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Grau
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Juergen A
authors.initials: JA
authors.lastname: Hampl
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Ann-Cathrin
authors.initials: AC
authors.lastname: Kohl
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Timmer
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Inga V
authors.initials: IV
authors.lastname: Duval
authors.affiliation: Department of Neuropathology, University of Cologne, Cologne, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Blau
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Maximilian I
authors.initials: MI
authors.lastname: Ruge
authors.affiliation: Department of Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Roland H
authors.initials: RH
authors.lastname: Goldbrunner
mesh_terms: D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D016371:Cranial Irradiation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000235:genetics; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009154:Mutation; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014944:World Health Organization; D055815:Young Adult
chemical_list: D007521:Isocitrate Dehydrogenase; C543588:IDH1 protein, human
keywords: Low-grade glioma; Malignant progression; Resection; Survival