A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy

Alexander J. Lin, Liam T. Kane, Jason K. Molitoris, Deborah R. Smith, Sonika Dahiya, Shahed N. Badiyan, Tony J.C. Wang, Tim J. Kruser, Jiayi Huang*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: Practice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort. Methods: Oligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without chemotherapy from 2000 to 2017 at four tertiary centers were retrospectively reviewed. Overall survival (OS), post-RT progression-free survival (PFS), freedom-from-RT (FFRT), and radiation necrosis (RN) rates were determined using Kaplan–Meier analyses. OS1/PFS1 were defined from the initial surgery. OS2/PFS2 were defined from the RT start-date. Multivariable analyses (MVAs) of prognostic factors for OS and PFS were performed with Cox regression. Results: One hundred eighty-six patients were identified: 124(67%) received aRT and 62(33%) received sRT; of sRT patients, 58% were observed after surgery while 42% received chemotherapy without aRT. The median time from initial diagnosis to sRT was 61 months, and 74% had reoperations before sRT. sRT had longer OS1 than aRT (94% vs. 69% at 10 years, p = 0.03) and PFS1 (10-year PFS of 80% vs. 68%, p = 0.03), though sRT was not associated with significantly different OS1/PFS1 on MVAs. Chemotherapy did not delay sRT compared to observation and had worse PFS2 (42% vs. 79% at 5 years, p = 0.08). Higher RT dose was not associated with improved clinical outcomes but was associated with higher symptomatic RN rate (15% vs. 0% at 2 years, p = 0.003). Conclusions: Delaying RT for selected oligodendroglioma patients appears safe. Adjuvant chemotherapy does not delay sRT longer than observation and may be associated with worse PFS after RT.

Original languageEnglish (US)
Pages (from-to)121-130
Number of pages10
JournalJournal of Neuro-Oncology
Volume146
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Oligodendroglioma
Salvage Therapy
Radiotherapy
Disease-Free Survival
Drug Therapy
Necrosis
Observation
Radiation
Survival
Adjuvant Chemotherapy
Reoperation
Outcome Assessment (Health Care)

Keywords

  • 1p/19q codeletion
  • Chemotherapy
  • Observation
  • Oligodendroglioma
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

Lin, Alexander J. ; Kane, Liam T. ; Molitoris, Jason K. ; Smith, Deborah R. ; Dahiya, Sonika ; Badiyan, Shahed N. ; Wang, Tony J.C. ; Kruser, Tim J. ; Huang, Jiayi. / A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy. In: Journal of Neuro-Oncology. 2020 ; Vol. 146, No. 1. pp. 121-130.
@article{c795d57dc0e941f2bdd4b6dcc228b535,
title = "A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy",
abstract = "Purpose: Practice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort. Methods: Oligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without chemotherapy from 2000 to 2017 at four tertiary centers were retrospectively reviewed. Overall survival (OS), post-RT progression-free survival (PFS), freedom-from-RT (FFRT), and radiation necrosis (RN) rates were determined using Kaplan–Meier analyses. OS1/PFS1 were defined from the initial surgery. OS2/PFS2 were defined from the RT start-date. Multivariable analyses (MVAs) of prognostic factors for OS and PFS were performed with Cox regression. Results: One hundred eighty-six patients were identified: 124(67{\%}) received aRT and 62(33{\%}) received sRT; of sRT patients, 58{\%} were observed after surgery while 42{\%} received chemotherapy without aRT. The median time from initial diagnosis to sRT was 61 months, and 74{\%} had reoperations before sRT. sRT had longer OS1 than aRT (94{\%} vs. 69{\%} at 10 years, p = 0.03) and PFS1 (10-year PFS of 80{\%} vs. 68{\%}, p = 0.03), though sRT was not associated with significantly different OS1/PFS1 on MVAs. Chemotherapy did not delay sRT compared to observation and had worse PFS2 (42{\%} vs. 79{\%} at 5 years, p = 0.08). Higher RT dose was not associated with improved clinical outcomes but was associated with higher symptomatic RN rate (15{\%} vs. 0{\%} at 2 years, p = 0.003). Conclusions: Delaying RT for selected oligodendroglioma patients appears safe. Adjuvant chemotherapy does not delay sRT longer than observation and may be associated with worse PFS after RT.",
keywords = "1p/19q codeletion, Chemotherapy, Observation, Oligodendroglioma, Radiation therapy",
author = "Lin, {Alexander J.} and Kane, {Liam T.} and Molitoris, {Jason K.} and Smith, {Deborah R.} and Sonika Dahiya and Badiyan, {Shahed N.} and Wang, {Tony J.C.} and Kruser, {Tim J.} and Jiayi Huang",
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A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy. / Lin, Alexander J.; Kane, Liam T.; Molitoris, Jason K.; Smith, Deborah R.; Dahiya, Sonika; Badiyan, Shahed N.; Wang, Tony J.C.; Kruser, Tim J.; Huang, Jiayi.

In: Journal of Neuro-Oncology, Vol. 146, No. 1, 01.01.2020, p. 121-130.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy

AU - Lin, Alexander J.

AU - Kane, Liam T.

AU - Molitoris, Jason K.

AU - Smith, Deborah R.

AU - Dahiya, Sonika

AU - Badiyan, Shahed N.

AU - Wang, Tony J.C.

AU - Kruser, Tim J.

AU - Huang, Jiayi

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Purpose: Practice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort. Methods: Oligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without chemotherapy from 2000 to 2017 at four tertiary centers were retrospectively reviewed. Overall survival (OS), post-RT progression-free survival (PFS), freedom-from-RT (FFRT), and radiation necrosis (RN) rates were determined using Kaplan–Meier analyses. OS1/PFS1 were defined from the initial surgery. OS2/PFS2 were defined from the RT start-date. Multivariable analyses (MVAs) of prognostic factors for OS and PFS were performed with Cox regression. Results: One hundred eighty-six patients were identified: 124(67%) received aRT and 62(33%) received sRT; of sRT patients, 58% were observed after surgery while 42% received chemotherapy without aRT. The median time from initial diagnosis to sRT was 61 months, and 74% had reoperations before sRT. sRT had longer OS1 than aRT (94% vs. 69% at 10 years, p = 0.03) and PFS1 (10-year PFS of 80% vs. 68%, p = 0.03), though sRT was not associated with significantly different OS1/PFS1 on MVAs. Chemotherapy did not delay sRT compared to observation and had worse PFS2 (42% vs. 79% at 5 years, p = 0.08). Higher RT dose was not associated with improved clinical outcomes but was associated with higher symptomatic RN rate (15% vs. 0% at 2 years, p = 0.003). Conclusions: Delaying RT for selected oligodendroglioma patients appears safe. Adjuvant chemotherapy does not delay sRT longer than observation and may be associated with worse PFS after RT.

AB - Purpose: Practice patterns vary for adjuvant treatment of 1p/19q-codeleted oligodendroglioma patients. This study evaluates the outcomes of adjuvant (aRT) versus salvage radiation therapy (sRT) in a multi-institutional cohort. Methods: Oligodendroglioma patients with confirmed 1p/19q codeletion who were treated with RT with or without chemotherapy from 2000 to 2017 at four tertiary centers were retrospectively reviewed. Overall survival (OS), post-RT progression-free survival (PFS), freedom-from-RT (FFRT), and radiation necrosis (RN) rates were determined using Kaplan–Meier analyses. OS1/PFS1 were defined from the initial surgery. OS2/PFS2 were defined from the RT start-date. Multivariable analyses (MVAs) of prognostic factors for OS and PFS were performed with Cox regression. Results: One hundred eighty-six patients were identified: 124(67%) received aRT and 62(33%) received sRT; of sRT patients, 58% were observed after surgery while 42% received chemotherapy without aRT. The median time from initial diagnosis to sRT was 61 months, and 74% had reoperations before sRT. sRT had longer OS1 than aRT (94% vs. 69% at 10 years, p = 0.03) and PFS1 (10-year PFS of 80% vs. 68%, p = 0.03), though sRT was not associated with significantly different OS1/PFS1 on MVAs. Chemotherapy did not delay sRT compared to observation and had worse PFS2 (42% vs. 79% at 5 years, p = 0.08). Higher RT dose was not associated with improved clinical outcomes but was associated with higher symptomatic RN rate (15% vs. 0% at 2 years, p = 0.003). Conclusions: Delaying RT for selected oligodendroglioma patients appears safe. Adjuvant chemotherapy does not delay sRT longer than observation and may be associated with worse PFS after RT.

KW - 1p/19q codeletion

KW - Chemotherapy

KW - Observation

KW - Oligodendroglioma

KW - Radiation therapy

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