Low-Grade Glioma May Do Better Without Surgical Therapy
Abstract & Commentary
Source: Reijneveld JC, et al. Cognitive status and quality of life in patients with suspected versus proven low-grade gliomas. Neurology. 2001;56:618-623.
Management of patients who develop first seizures later than 16-18 years of age usually includes brain imaging which, in the United States, is performed by MRI. Current quality of this technology can identify the probability of low-grade glioma, particularly in first-diagnosed persons younger than 40-45 years. At least in Europe, many neurologists defer early surgical resection or biopsy as well as unproved radiation therapy in these younger persons. Shafqat and colleagues found that low-grade astrocytomas diagnosed in patients between 10-45 years averaged 44 ± 17 months to transform into malignancy (see Plum F. Neurology Alert 1999;17:70-71). Survival averaged 58 months. Persons who suffered the onset of similar tumors at age 45 and older averaged only 7.5 months for malignant transformation and died an average of 14 months later for identification.
Reijneveld and associates selected 48 persons with low-grade gliomas who were first diagnosed in 2 groups: 24 were diagnosed at an average age of 38.4 ± 7.6 years based on clinical and brain image findings alone; the other 24 were diagnosed by surgical resection or stereotaxic biopsy at an average age of 32.7 ± years. All patients were studied between June 1998 and July 1999. All were 18 years of age or older and showed nonenhancing supratentorial lesions on MRI or CT. None had signs of progression during at least the 6 months before examination. The nonsurgical group was evaluated 4.4 years after the initial noninvasive diagnosis compared to a 5.5 year lapse for the histologically proved group.
Quality of life represented the given outcome expression between the 2 groups, one presumptive of glioma and the other with a proved diagnosis. Overall, quality of life in either group was less than what 24 healthy controls achieved. The surgical group, however, proved to do worse than the nonsurgical group in quality behavior of life. The surgical group had more complaints, but had insignificantly self-rating cognitive capacities.
Reijneveld et al conclude that young, 18-40-year-old patients with low-grade gliomas inevitably undergo impaired cognitive functioning and they measurably do better in daily behavior than do patients with similar diagnoses who receive early therapy, either surgical removal or radiation therapy.
This report is relatively short but states its findings accurately and clearly. Apparently, some of their patients must have been older than 50, thus being vulnerable for a shortened life. That would not be apparent in this report, but Shafqat et al discuss that directly in their report (Shafqat S, et al. Neurology 1999;52:867-869). —Fred Plum