LOW GRADE GLIOMAS-BETTER TO TREAT EARLY 

Comparison of a Strategy Favoring Early Surgical Resection vs a Strategy Favoring Watchful Waiting in Low-Grade Gliomas

Jakola AS, Myrmel KS, Kloster R, et al

JAMA. 2012;308:1881-1888

Summary

What is the best treatment strategy for patients with low-grade gliomas of the brain? In this unique Norwegian study, the investigators took advantage of a regional difference in therapeutic approaches by 2 hospitals in adjacent geographic regions. Hospital A performed biopsies and then took a watch-and-wait approach in 71% of patients. Hospital B favored early surgery in 86% of patients. After a median follow-up of about 7 years, the results strongly favored the method used in hospital B, where early surgery resulted in an estimated 5-year survival of 74% compared with 60% in the watch-and-wait group.

Viewpoint

The results of surgery on this type of brain cancer have been unclear. These tumors are often considered incurable, with eventual spread of disease to the nonresected portion of the brain.

This retrospective study that was performed for more than a decade took advantage of a regional difference in treatment patterns. The results strongly favor a more aggressive approach to the treatment of these lesions. Although the trial was not randomized and the tumor or patient characteristics might have differed between the 2 centers, the results lend considerable weight to a more aggressive treatment approach