Patients in Norway with low-grade gliomas who were treated with early surgical resection had better overall survival than those treated with biopsy and watchful waiting, according to the results of a study published in the Journal of the American Medical Association.
Approximately 20,000 individuals are diagnosed annually in the U.S. with cancer that originates in the brain. There are several different types of brain cancer; they are distinguished by the cells in the brain where the cancer originates, the extent of spread, aggressiveness of the cancer, and characteristics of the cancer.
Gliomas are the most common type of brain cancer. Low-grade gliomas are slow-growing gliomas, while high-grade gliomas are more aggressive gliomas. Prognosis for gliomas, particularly high-grade gliomas, remains poor.
Standard treatment for gliomas often consists of surgery, chemotherapy, radiation therapy and/or biologic therapy; however, specific treatment guidelines for gliomas have not been well defined—and management of low-grade gliomas is controversial.
Researchers from Norway compared two different treatment strategies at two hospitals: one hospital favored biopsy and watchful waiting (wait and scan) and the other favored early surgical resection. Both hospitals are exclusive providers in adjacent geographical regions with regional referral practices. In other words, the treatment strategy for individual patients is highly dependent on their residential address.
The study included 153 patients with low-grade glioma—66 from the hospital favoring biopsy and watchful waiting and 87 from the hospital favoring early resection. At the hospital favoring biopsy and watchful waiting, 71 perent of patients underwent initial biopsy alone, compared to only 14 percent at the hospital favoring early resection. After an initial follow-up of seven years, the researchers found that overall survival was significantly better with early surgical resection—32 percent of patients had died at the hospital favoring early resection, compared to 52 percent at the hospital favoring biopsy and watchful waiting. The median survival at the hospital favoring biopsy and watchful waiting was 5.9 years, while the median survival at the other hospital had not yet been reached. Estimated 5-year survival was 60 percent for biopsy and watchful waiting and 74 percent for early resection.
The researchers concluded that treatment for low-grade gliomas at a center that favored early resection was associated with better overall survival than treatment at a center that favored biopsy and watchful waiting. This survival benefit remained after adjusting for validated prognostic factors.
Jakola AS, Myrmel KS, Kloster R, et al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. Journal of the American Medical Association. 2012; 08(18):1881-1888.