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Stellenwert und Komplikationsraten stereotaktischer Probenentnahmen in der Gliomdiagnostik und -therapie
Stellenwert und Komplikationsraten stereotaktischer Probenentnahmen in der Gliomdiagnostik und -therapie
Histopathological and molecular characterization of gliomas is necessary to determine subtype and therapy of the tumor. Tissue sampling through open resection or biopsy is possible. Different biopsy techniques are used when resection is deemed not safely feasible. Postoperative strategies for treatment of isocitrate dehydrogenase (IDH)-mutant astrocytomas are controversial. We first aimed at determining the safety and efficacy of stereotactic biopsies in patients with suspected gliomas overall and secondly investigated outcome of patients with IDH-mutant astrocytomas according to different treatment strategies after diagnosis through stereotactic biopsy or tumor resection: wait-and-scan, radiotherapy or temozolomide. Temozolomide has been reported to be associated with poor outcome in some patients with IDH-mutant astrocytomas. We retrospectively screened our databases for patients that had undergone stereotactic biopsies for suspected glioma between January 2016 and March 2021. Patient characteristics and procedural data were assessed. Complication rates were determined according to the Common Terminology Criteria for Adverse Events Version 5 (CTCAE). Additionally, patients diagnosed with IDH-mutant astrocytomas WHO grade 2 or 3 (n=183), either diagnosed by biopsy or resection, were further investigated for progression-free and overall survival. The cohort was stratified according to the postoperative strategy: wait-and-scan (n=98), radiotherapy (n=37) or temozolomide alone (n=48). Subgroup and matched-pair analyses were conducted. Within the biopsy cohort of 1’214 individual patients, 617 patients (50.8%) received a biopsy for a newly diagnosed lesion and 597 patients (49.2%) for a suspected recurrence. An integrated diagnosis was possible in 96.3% of all patients. IDH wildtype glioblastoma was the most frequent diagnosis with 596 patients (49.2%) affected, followed by oligodendroglioma WHO grade 2 (n = 109; 9%), astrocytoma WHO grade 3 (n = 108; 8.9%), oligodendroglioma WHO grade 3 (n = 76; 6.3%), and astrocytoma WHO grade 2 (n = 66; 5.4%). Peri-procedural complications CTCAE grade 3 or higher occurred in 1.2% of patients overall with no fatal outcome. In the treatment of IDH-mutant astrocytomas, radiotherapy alone was associated with better overall survival than temozolomide alone (14.4 vs 10.7 years, p=0.02). Patients from the wait-and-scan cohort also lived significantly longer than patients treated with temozolomide (not reached vs 10.7 years, p<0.01). This association was confirmed in subgroup and matched-pair analyses. Image-guided, stereotactic biopsies yield diagnoses with high accuracy and low peri-procedural complication rates initially and during clinical course. The implication of temozolomide chemotherapy alone in IDH-mutant astrocytomas remains uncertain and potential detrimental effects on outcome need to be further evaluated.
Not available
Katzendobler, Sophie
2023
German
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Katzendobler, Sophie (2023): Stellenwert und Komplikationsraten stereotaktischer Probenentnahmen in der Gliomdiagnostik und -therapie. Dissertation, LMU München: Faculty of Medicine
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Abstract

Histopathological and molecular characterization of gliomas is necessary to determine subtype and therapy of the tumor. Tissue sampling through open resection or biopsy is possible. Different biopsy techniques are used when resection is deemed not safely feasible. Postoperative strategies for treatment of isocitrate dehydrogenase (IDH)-mutant astrocytomas are controversial. We first aimed at determining the safety and efficacy of stereotactic biopsies in patients with suspected gliomas overall and secondly investigated outcome of patients with IDH-mutant astrocytomas according to different treatment strategies after diagnosis through stereotactic biopsy or tumor resection: wait-and-scan, radiotherapy or temozolomide. Temozolomide has been reported to be associated with poor outcome in some patients with IDH-mutant astrocytomas. We retrospectively screened our databases for patients that had undergone stereotactic biopsies for suspected glioma between January 2016 and March 2021. Patient characteristics and procedural data were assessed. Complication rates were determined according to the Common Terminology Criteria for Adverse Events Version 5 (CTCAE). Additionally, patients diagnosed with IDH-mutant astrocytomas WHO grade 2 or 3 (n=183), either diagnosed by biopsy or resection, were further investigated for progression-free and overall survival. The cohort was stratified according to the postoperative strategy: wait-and-scan (n=98), radiotherapy (n=37) or temozolomide alone (n=48). Subgroup and matched-pair analyses were conducted. Within the biopsy cohort of 1’214 individual patients, 617 patients (50.8%) received a biopsy for a newly diagnosed lesion and 597 patients (49.2%) for a suspected recurrence. An integrated diagnosis was possible in 96.3% of all patients. IDH wildtype glioblastoma was the most frequent diagnosis with 596 patients (49.2%) affected, followed by oligodendroglioma WHO grade 2 (n = 109; 9%), astrocytoma WHO grade 3 (n = 108; 8.9%), oligodendroglioma WHO grade 3 (n = 76; 6.3%), and astrocytoma WHO grade 2 (n = 66; 5.4%). Peri-procedural complications CTCAE grade 3 or higher occurred in 1.2% of patients overall with no fatal outcome. In the treatment of IDH-mutant astrocytomas, radiotherapy alone was associated with better overall survival than temozolomide alone (14.4 vs 10.7 years, p=0.02). Patients from the wait-and-scan cohort also lived significantly longer than patients treated with temozolomide (not reached vs 10.7 years, p<0.01). This association was confirmed in subgroup and matched-pair analyses. Image-guided, stereotactic biopsies yield diagnoses with high accuracy and low peri-procedural complication rates initially and during clinical course. The implication of temozolomide chemotherapy alone in IDH-mutant astrocytomas remains uncertain and potential detrimental effects on outcome need to be further evaluated.