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J Neurol Surg A Cent Eur Neurosurg 2020; 81(01): 048-057
DOI: 10.1055/s-0039-1693650
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Multicentric Registry Study on Epidemiological and Biological Disease Profile as Well as Clinical Outcome in Patients with Low-Grade Gliomas: The LoG-Glio Project

Andrej Pala
1   Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
,
Minou Nadji-Ohl
2   Department of Neurosurgery, Katharinenhospital Stuttgart, Kriegsbergstr, Stuttgart, Germany
,
Katharina Faust
3   Department of Neurosurgery, Charité - University of Berlin, Charitéplatz, Berlin, Germany
,
Stefan Rückriegel
4   Department of Neurosurgery, University of Würzburg, Josef-Schneider-Strasse, Würzburg, Germany
,
Constantin Roder
5   Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
,
Christian von der Brelie
6   Department of Neurosurgery, University of Göttingen, Robert-Koch-Strasse, Göttingen, Germany
,
Marie-Therese Forster
7   Department of Neurosurgery, University of Frankfurt, Schleusenweg, Frankfurt am Main, Germany
,
Franziska Löbel
3   Department of Neurosurgery, Charité - University of Berlin, Charitéplatz, Berlin, Germany
,
Stefan Schommer
2   Department of Neurosurgery, Katharinenhospital Stuttgart, Kriegsbergstr, Stuttgart, Germany
,
Mario Löhr
4   Department of Neurosurgery, University of Würzburg, Josef-Schneider-Strasse, Würzburg, Germany
,
Mirjam Renovanz
5   Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
,
Nadja Grübel
1   Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
,
Dietrich Rothenbacher
8   Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholzstrasse, Ulm, Germany
,
Ralph König
1   Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
,
Jens Engelke
1   Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
,
Bernd Schmitz
9   Department of Neuroradiology, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
,
Christian Rainer Wirtz
1   Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
,
Florian Ringel
10   Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
,
Christian Senft
7   Department of Neurosurgery, University of Frankfurt, Schleusenweg, Frankfurt am Main, Germany
,
Veit Rohde
6   Department of Neurosurgery, University of Göttingen, Robert-Koch-Strasse, Göttingen, Germany
,
Marcos Tatagiba
5   Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
,
Ralf Ingo Ernestus
4   Department of Neurosurgery, University of Würzburg, Josef-Schneider-Strasse, Würzburg, Germany
,
Peter Vajkoczy
3   Department of Neurosurgery, Charité - University of Berlin, Charitéplatz, Berlin, Germany
,
Oliver Ganslandt
2   Department of Neurosurgery, Katharinenhospital Stuttgart, Kriegsbergstr, Stuttgart, Germany
,
Gabriele Nagel
8   Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholzstrasse, Ulm, Germany
,
Jan Coburger
1   Department of Neurosurgery, University of Ulm, Ludwig Heilmeyerstr, Günzburg, Germany
› Author Affiliations Trial registration NCT02686229 Clinical trials.
Further Information

Publication History

02 June 2018

03 April 2019

Publication Date:
24 September 2019 (online)

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Erratum: Multicentric Registry Study on Epidemiological and Biological Disease Profile as Well as Clinical Outcome in Patients with Low-Grade Gliomas: The LoG-Glio ProjectJ Neurol Surg A Cent Eur Neurosurg 2020; 81(01): e1-e1
DOI: 10.1055/s-0040-1712923

Abstract

Background World Health Organization (WHO) grade II low-grade gliomas (LGGs) in adults are rare, and patients' mean overall survival (OS) is relatively long. Epidemiological data on factors influencing tumor genesis and progression are scarce, and prospective data on surgical management are still lacking. Because of the molecular heterogeneity of LGG, a comprehensive molecular characterization is required for any clinical and epidemiological research. Further, a detailed radiologic assessment is needed as the only established objective criterion for progressive disease. Both radiologic and molecular assessments have to be standardized to produce comparable data. The aim of the registry is to improve the evidence for surgical management of LGG patients by establishing a multicenter registry with a strong surgical and clinical focus including mandatory biobanking.

Methods The LoG-Glio project is a prospective national observational multicenter registry that began on November 1, 2015. Inclusion criteria encompass all patients > 18 years of age with a radiologic suspicion of LGG. Patients with severe neurologic or psychiatric disorders that may interfere with their informed consent or if there is no possibility for further follow-up are excluded. Diagnosis of glioblastoma WHO grade IV isocitrate dehydrogenase (IDH) wild type leads to a secondary exclusion of patients. In addition to demographic data, results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, add-on for patients with brain tumors, and National Health Institute Stroke Scale before and after surgery and during regular follow-ups are collected. At each time point a detailed recording of surgical and adjuvant treatment is performed. Radiologic assessment involves three-dimensional (3D) acquisition of T1, fluid-attenuated inversion recovery, and T2 sequences. For the final evaluation, a central detailed neuropathologic and molecular assessment of tumor samples and a radiologic evaluation of imaging sets are part of the study protocol.

Results We report the first 100 consecutively registered patients for LoG-Glio. Three patients dropped out due to loss of follow-up. Of the remaining recruited patients, 8 were classified as wait and scan; 89 had surgery. Using the inclusion criteria described previously, 70 patients had an IDH-mutated glioma, 10 had miscellaneous rare LGGs, and 8 patients had an IDH wild-type WHO grade II or III glioma.

Conclusion The LoG-Glio registry has been successfully implemented. Applied selection criteria result in an appropriately balanced patient cohort. Short-term outcome data on epidemiology as well as the influence of current surgical techniques and adjuvant treatment on patient outcomes are expected. In the long run, the aim of the registry is to validate the new molecular-based WHO classification and the influence of the extent of resection on progression-free survival and OS. The registry provides an open platform for future research projects benefiting patients with LGG.

Keywords

low-grade glioma - register - IDH - extent of resection - overall survival - progression-free survival - quality of life
 

  • References

  • 1 Bradley S, Sherwood PR, Donovan HS. , et al. I could lose everything: understanding the cost of a brain tumor. J Neurooncol 2007; 85 (03) 329-338
    CrossrefPubMedGoogle Scholar
  • 2 Ho VKY, Reijneveld JC, Enting RH. , et al; Dutch Society for Neuro-Oncology (LWNO). Changing incidence and improved survival of gliomas. Eur J Cancer 2014; 50 (13) 2309-2318
    CrossrefPubMedGoogle Scholar
  • 3 Rees J, Watt H, Jäger HR. , et al. Volumes and growth rates of untreated adult low-grade gliomas indicate risk of early malignant transformation. Eur J Radiol 2009; 72 (01) 54-64
    CrossrefPubMedGoogle Scholar
  • 4 Ostrom QT, Bauchet L, Davis FG. , et al. The epidemiology of glioma in adults: a “state of the science” review. Neuro Oncol 2014; 16 (07) 896-913
    CrossrefPubMedGoogle Scholar
  • 5 Bondy ML, Scheurer ME, Malmer B. , et al; Brain Tumor Epidemiology Consortium. Brain tumor epidemiology: consensus from the Brain Tumor Epidemiology Consortium. Cancer 2008; 113 (7, Suppl): 1953-1968
    CrossrefPubMedGoogle Scholar
  • 6 Sadetzki S, Chetrit A, Freedman L, Stovall M, Modan B, Novikov I. Long-term follow-up for brain tumor development after childhood exposure to ionizing radiation for tinea capitis. Radiat Res 2005; 163 (04) 424-432
    CrossrefPubMedGoogle Scholar
  • 7 McCarthy BJ, Rankin KM, Aldape K. , et al. Risk factors for oligodendroglial tumors: a pooled international study. Neuro Oncol 2011; 13 (02) 242-250
    CrossrefPubMedGoogle Scholar
  • 8 Linos E, Raine T, Alonso A, Michaud D. Atopy and risk of brain tumors: a meta-analysis. J Natl Cancer Inst 2007; 99 (20) 1544-1550
    CrossrefPubMedGoogle Scholar
  • 9 McGirt MJ, Chaichana KL, Attenello FJ. , et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 2008; 63 (04) 700-707 ; author reply 707–708
    CrossrefPubMedGoogle Scholar
  • 10 Coburger J, Merkel A, Scherer M. , et al. Low-grade glioma surgery in intraoperative magnetic resonance imaging: results of a multicenter retrospective assessment of the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery 2016; 78 (06) 775-786
    CrossrefPubMedGoogle Scholar
  • 11 Pala A, König R, Hlavac M, Wirtz CR, Coburger J. Does the routine use of intraoperative MRI prolong progression free survival in low-grade glioma surgery? A retrospective study. Innovative Neurosurg. 2015; 3: 109-8
    PubMedGoogle Scholar
  • 12 Louis DN, Perry A, Reifenberger G. , et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016; 131 (06) 803-820
    CrossrefPubMedGoogle Scholar
  • 13 Brat DJ, Verhaak RG, Aldape KD. , et al; Cancer Genome Atlas Research Network. Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med 2015; 372 (26) 2481-2498
    CrossrefPubMedGoogle Scholar
  • 14 Schüz J, Elliott P, Auvinen A. , et al. An international prospective cohort study of mobile phone users and health (Cosmos): design considerations and enrolment. Cancer Epidemiol 2011; 35 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 15 Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke 1997; 28 (02) 307-310
    CrossrefPubMedGoogle Scholar
  • 16 Olson R, Tyldesley S, Carolan H, Parkinson M, Chhanabhai T, McKenzie M. Prospective comparison of the prognostic utility of the Mini Mental State Examination and the Montreal Cognitive Assessment in patients with brain metastases. Support Care Cancer 2011; 19 (11) 1849-1855
    CrossrefPubMedGoogle Scholar
  • 17 Nasreddine ZS, Phillips N, Chertkow H. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology 2012; 78 (10) 765-766 ; author reply 766
    PubMedGoogle Scholar
  • 18 Olson RA, Chhanabhai T, McKenzie M. Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Support Care Cancer 2008; 16 (11) 1273-1278
    CrossrefPubMedGoogle Scholar
  • 19 Wen PY, Macdonald DR, Reardon DA. , et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28 (11) 1963-1972
    CrossrefPubMedGoogle Scholar
  • 20 Dupont WD, Plummer WD. Power and sample size calculations. A review and computer program. Control Clin Trials 1990; 11: 116-28
    CrossrefPubMedGoogle Scholar
  • 21 Schoenfeld DA, Richter JR. Nomograms for calculating the number of patients needed for a clinical trial with survival as an endpoint. Biometrics 1982; 38: 163-70
    CrossrefPubMedGoogle Scholar
  • 22 Weller M, van den Bent M, Hopkins K. , et al; European Association for Neuro-Oncology (EANO) Task Force on Malignant Glioma. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014; 15 (09) e395-e403
    CrossrefPubMedGoogle Scholar
  • 23 Marko NF, Weil RJ, Schroeder JL, Lang FF, Suki D, Sawaya RE. Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximum-safe-resection approach to surgery. J Clin Oncol 2014; 32 (08) 774-782
    CrossrefPubMedGoogle Scholar
  • 24 Buckner JC, Shaw EG, Pugh SL. , et al. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 2016; 374 (14) 1344-1355
    CrossrefPubMedGoogle Scholar
  • 25 Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 2011; 12 (11) 997-1003
    CrossrefPubMedGoogle Scholar
  • 26 Duffau H, Taillandier L. New concepts in the management of diffuse low-grade glioma: proposal of a multistage and individualized therapeutic approach. Neuro Oncol 2015; 17 (03) 332-342
    CrossrefPubMedGoogle Scholar
  • 27 Duffau H, Capelle L. Preferential brain locations of low-grade gliomas. Cancer 2004; 100 (12) 2622-2626
    CrossrefPubMedGoogle Scholar
  • 28 Capelle L, Fontaine D, Mandonnet E. , et al; French Réseau d'Étude des Gliomes. Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg 2013; 118 (06) 1157-1168
    CrossrefPubMedGoogle Scholar
  • 29 Pala A, Brand C, Kapapa T. , et al. The value of intraoperative and early postoperative MRI in low-grade glioma surgery: a retrospective study. World Neurosurg 2016; 93: 191-197
    CrossrefPubMedGoogle Scholar
  • 30 Hartmann C, Hentschel B, Wick W. , et al. Patients with IDH1 wild type anaplastic astrocytomas exhibit worse prognosis than IDH1-mutated glioblastomas, and IDH1 mutation status accounts for the unfavorable prognostic effect of higher age: implications for classification of gliomas. Acta Neuropathol 2010; 120 (06) 707-718
    CrossrefPubMedGoogle Scholar
  • 31 Cairncross G, Wang M, Shaw E. , et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 2013; 31 (03) 337-343
    PubMedGoogle Scholar
  • 32 van den Bent MJ, Brandes AA, Taphoorn MJB. , et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 2013; 31 (03) 344-350
    PubMedGoogle Scholar
  • 33 Weiler M, Wick W. Molecular predictors of outcome in low-grade glioma. Curr Opin Neurol 2012; 25 (06) 767-773
    CrossrefPubMedGoogle Scholar
  • 34 Woehrer A. Brain tumor epidemiology in Austria and the Austrian Brain Tumor Registry. Clin Neuropathol 2013; 32 (04) 269-285
    CrossrefPubMedGoogle Scholar
  • 35 Georgakis MK, Karalexi MA, Kalogirou EI. , et al. Incidence, time trends and survival patterns of childhood pilocytic astrocytomas in Southern-Eastern Europe and SEER, US. J Neurooncol 2017; 131 (01) 163-175
    CrossrefPubMedGoogle Scholar
  • 36 Asklund T, Malmström A, Bergqvist M, Björ O, Henriksson R. Brain tumors in Sweden: data from a population-based registry 1999–2012. Acta Oncol 2015; 54 (03) 377-384
    CrossrefPubMedGoogle Scholar
  • 37 Jeswani S, Nuño M, Folkerts V, Mukherjee D, Black KL, Patil CG. Comparison of survival between cerebellar and supratentorial glioblastoma patients: surveillance, epidemiology, and end results (SEER) analysis. Neurosurgery 2013; 73 (02) 240-246 ; discussion 246; quiz 246
    CrossrefPubMedGoogle Scholar
  • 38 Alattar AA, Brandel MG, Hirshman BR. , et al. Oligodendroglioma resection: a Surveillance, Epidemiology, and End Results (SEER) analysis. J Neurosurg 2018; 128 (04) 1076-1083
    CrossrefPubMedGoogle Scholar