title: Does early resection of presumed low-grade glioma improve survival? A clinical perspective.
abstract: Early resection is standard of care for presumed low-grade gliomas. This is based on studies including only tumors that were post-surgically confirmed as low-grade glioma. Unfortunately this does not represent the clinicians' situation wherein he/she has to deal with a lesion on MRI that is suspect for low-grade glioma (i.e. without prior knowledge on the histological diagnosis). We therefore aimed to determine the optimal initial strategy for patients with a lesion suspect for low-grade glioma, but not histologically proven yet. We retrospectively identified 150 patients with a resectable presumed low-grade-glioma and who were otherwise in good clinical condition. In this cohort we compared overall survival between three types of initital treatment strategy: a wait-and-scan approach (n = 38), early resection (n = 83), or biopsy for histopathological verification (n = 29). In multivariate analysis, no difference was observed in overall survival for early resection compared to wait-and-scan: hazard ratio of 0.92 (95% CI 0.43-2.01; p = 0.85). However, biopsy strategy showed a shorter overall survival compared to wait-and-scan: hazard ratio of 2.69 (95% CI 1.19-6.06; p = 0.02). In this cohort we failed to confirm superiority of early resection over a wait-and-scan approach in terms of overall survival, though longer follow-up is required for final conclusion. Biopsy was associated with shorter overall survival.
authors.affiliation: Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands. m.wijnenga@erasmusmc.nl.
authors.forename: Maarten M J
authors.initials: MMJ
authors.lastname: Wijnenga
authors.affiliation: Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
authors.forename: Tariq
authors.initials: T
authors.lastname: Mattni
authors.affiliation: Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
authors.forename: Pim J
authors.initials: PJ
authors.lastname: French
authors.affiliation: Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Rutten
authors.affiliation: Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.|Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Sieger
authors.initials: S
authors.lastname: Leenstra
authors.affiliation: Department of Neurosurgery, Haaglanden Medical Centre, The Hague, The Netherlands.
authors.forename: Fred
authors.initials: F
authors.lastname: Kloet
authors.affiliation: Department of Neurology, Haaglanden Medical Centre, The Hague, The Netherlands.
authors.forename: Martin J B
authors.initials: MJB
authors.lastname: Taphoorn
authors.affiliation: Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: van den Bent
authors.affiliation: Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
authors.forename: Clemens M F
authors.initials: CMF
authors.lastname: Dirven
authors.affiliation: Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
authors.forename: Marie-Lise
authors.initials: ML
authors.lastname: van Veelen
authors.affiliation: Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands. a.vincent@erasmusmc.nl.
authors.forename: Arnaud J P E
authors.initials: AJPE
authors.lastname: Vincent
mesh_terms: D000328:Adult; D001706:Biopsy; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000072700:Conservative Treatment; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: Biopsy; Diffuse low-grade glioma; Resection; Survival; Wait-and-scan