Invasion is not an independent prognostic factor in high-grade glioma
Ashwatha Narayana1, Donato Perretta2, Saroj Kunnakkat2, Deborah Gruber3, John Golfinos4, Erik Parker4, Praveen Medabalmi5, David Zagzag6, RN Pat Eagan3, Michael Gruber3
1 Department of Radiation Oncology and Neurosurgery, New York University Langone Medical Center, New York, NY 10016, USA
2 Department of Radiation Oncology, New York University Langone Medical Center, New York, NY 10016, USA
3 Neuro-Oncology Atlantic Health System, Overlook Hospital, Summit, NJ 07901, USA
4 Department of Neurosurgery, New York University Langone Medical Center, New York, NY 10016, USA
5 Department of Biostatistics, New York University Langone Medical Center, New York, NY 10016, USA
6 Department of Neuropathology, New York University Langone Medical Center, New York, NY 10016, USA
Department of Radiation Oncology, New York University Langone Medical Center, 550 1st Ave., New York, NY 10016
Source of Support: None, Conflict of Interest: None
Purpose: The role of invasion as a prognostic factor in high-grade gliomas (HGG) remains controversial. An apparent increase in invasiveness following anti-angiogenic therapy makes this question clinically relevant. The goal of this study is to assess survival differences in patients with newly diagnosed HGG who present with diffuse invasive disease compared to those who did not, but went on to develop diffuse invasive disease following bevacizumab therapy.
Materials and Methods: Twenty-three patients presented as newly diagnosed diffuse invasive HGG. All patients underwent surgical resection with radiation therapy and temozolomide for one year. Progression-free survival (PFS) and overall survival (OS) were compared to a control of 58 patients with focal high-grade glioma who received similar therapy, but that included bevacizumab at 10 mg/kg given every two weeks.
Results: The patient characteristics were similar in each group. The median PFS and OS for invasive HGG patients were 6 and 13 months and for the focal HGG patients, 11 and 24 months, respectively (P=0.092 and P=0.071). In the subgroup of invasive HGG that showed significant angiogenesis, the median PFS and OS were 3 and 9 months, respectively. 56% of the focal HGG patients recurred as diffuse invasive relapse. For patients with focal HGG who recurred as invasive disease, the median PFS and OS were 9 and 21 months respectively.
Conclusions: Presence of diffuse invasive disease not accompanied by angiogenesis either prior to therapy or subsequent to anti-angiogenic therapy does not seem to have prognostic significance. However, invasion accompanied by angiogenesis in newly diagnosed HGG may confer a poor prognosis.