Upfront chemotherapy and subsequent resection for molecularly defined gliomas

Hikaru Sasaki, Yuichi Hirose, Takahito Yazaki, Yohei Kitamura, Makoto Katayama, Tokuhiro Kimura, Hirokazu Fujiwara, Masahiro Toda, Takayuki Ohira, Kazunari Yoshida

研究成果: Article査読

12 被引用数 (Scopus)

抄録

Functional preservation is critical in glioma surgery, and the extent of resection influences survival outcome. Neoadjuvant chemotherapy is a promising option because of its potential to facilitate tumor shrinkage and maximum tumor resection. The object of this study was to assess the utility of the neoadjuvant strategy in a prospective series of gliomas with favorable molecular status. Twenty-six consecutive cases of diffuse gliomas of WHO grade II or III with either 1p19q codeletion or MGMT methylation were treated with upfront chemotherapy following maximal safe removal. In cases of incomplete initial surgery, second-look resection was intended after tumor volume decrease by chemotherapy. Among 22 evaluable cases, chemotherapy led to a median change in the sum of the product of perpendicular diameters of −35 %, and 14 out of the 22 cases (64 %) showed objective response. Second-look resection after tumor volume decrease was performed in 12 out of 19 cases of incomplete initial surgery (GTR/STR 9, removal of residual methionine PET uptake 3). The median progression-free survival among the 22 patients with grade II tumors was 57 months, with some cases showing durable progression-free survival after second-look resection. MIB-1 indices of the second-look resected tumors were lower than those of the initial tumors, and the methylation status of the MGMT gene was unchanged. Neoadjuvant chemotherapy based on molecular guidance often produces significant volume decrease of incompletely resected gliomas. Radical second-look resection is an optional advantage of upfront chemotherapy for chemosensitive gliomas compared with initial radiotherapy.

本文言語English
ページ(範囲)127-135
ページ数9
ジャーナルJournal of Neuro-Oncology
124
1
DOI
出版ステータスPublished - 23-08-2015

All Science Journal Classification (ASJC) codes

  • 腫瘍学
  • 神経学
  • 臨床神経学
  • 癌研究

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