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Radiation Oncology • Neuro-Oncology
Is the criteria for RT + PCV for low grade glioma too narrow?
RTOG 9802 showed a large overall survival benefit for the addition of PCV to radiotherapy in patients with "high-risk" low grade glioma (either age > 40 or subtotal resection).
We know from prior studies that radiotherapy alone does not alter overall survival, and 50% of patients with "low-risk" low grade glioma (age <40 or gross-total resection) will progress by 5 years if observed.
Suppose you have a 35 year old patient with gross-total resection. This patient would have qualified for RTOG 9802 if she was 40 years old. Is there a biologic basis to think that RT + PCV would not be beneficial due to age alone?
Answer from: Radiation Oncologist at Academic Institution
This is an excellent question, which unfortunately does not have a straightforward answer. The first and obvious answer is that 9802 evaluated patients older than 40 or less than 40 only if they had a subtotal resection, and therefore the specific benefit of RT+PCV in those less than 40 with a GTR c...
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Answer from: Radiation Oncologist at Community Practice
The issue with low risk and high risk is not progression free survival as they appear to be very similar in RTOG 9802 but overall survival which is significantly lower for high risk in comparison to low risk. The end point for adding chemo is improving survival and not progression free survival and ...
Answer from: Radiation Oncologist at Academic Institution
We do not know the answer to your question with certainly. It has been felt for years that the biology of “low grade glioma” becomes more aggressive with age. Age of 40 years or 50 years is a statistical cut-off. For a 35-year old with complete resection, most people would observe and u...