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Effect of neoadjuvant temozolomide upon volume reduction and resection of diffuse low-grade glioma.
- Source :
-
Journal of neuro-oncology [J Neurooncol] 2014 Oct; Vol. 120 (1), pp. 155-61. Date of Electronic Publication: 2014 Jul 20. - Publication Year :
- 2014
-
Abstract
- Maximal safe resection is associated with prolonged survival in patients with low-grade glioma (LGG). It has been suggested that neoadjuvant temozolomide may provide sufficient tumor shrinkage to facilitate aggressive surgical debulking. We examined the impact of temozolomide upon volume reduction and resectability of LGG. We retrospectively identified 20 adult patients with biopsy-proven, deemed not totally resectable LGGs, treated initially with temozolomide. Volumetric 3D (calculated from serial FLAIR images) and 2D tumor measurements were obtained prior to treatment and at 3 months post-treatment. The anticipated extent of resection (EOR) at the 2 time points was measured based on anatomical limitations, calculated as: [(total tumor volume - unresectable tumor volume)/total tumor volume] ×100. Eloquent cortex, deep structures and corpus callosum were considered unresectable. Mean tumor volume was 68.4 cm(3) pre-treatment and 49.5 cm(3) at 3 months post-treatment. The mean change from baseline to 3 months after treatment was -32.5 % (p < 0.001). Mean 2D pre-treatment area was 28.6 and 23.3 cm(2) at 3 months post-treatment. The 2D change was also significant, with mean change of -17% (p < 0.001). 5% had partial response; 40% minor response; 45% stable disease; and 10% progressive disease by RANO criteria. Mean pre-treatment anticipated EOR was 67.2 and 71.5% at 3 months post-treatment. The mean change from baseline was 4.3% (p = 0.10). Our findings demonstrate significant volumetric and 2D reduction of LGG with temozolomide. Although this tumor shrinkage might facilitate radical surgical resection in some cases, our data failed to show statistically significant improvement in anticipated EOR.
- Subjects :
- Adult
Aged
Aged, 80 and over
Brain Neoplasms mortality
Brain Neoplasms pathology
Combined Modality Therapy
Dacarbazine therapeutic use
Female
Follow-Up Studies
Glioma mortality
Glioma pathology
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Grading
Prognosis
Retrospective Studies
Survival Rate
Temozolomide
Tumor Burden
Antineoplastic Agents, Alkylating therapeutic use
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Brain Neoplasms therapy
Dacarbazine analogs & derivatives
Glioma therapy
Neoadjuvant Therapy
Neurosurgical Procedures
Subjects
Details
- Language :
- English
- ISSN :
- 1573-7373
- Volume :
- 120
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of neuro-oncology
- Publication Type :
- Academic Journal
- Accession number :
- 25038848
- Full Text :
- https://doi.org/10.1007/s11060-014-1538-7