Treatment patterns and outcomes in high-risk WHO grade 2 diffuse glioma: a multicentre retrospective cohort study.
Summary
This retrospective multicenter Canadian study investigated treatment patterns and outcomes in 116 patients with high-risk WHO grade 2 diffuse glioma, treated with radiotherapy and adjuvant alkylating chemotherapy (temozolomide or PCV). Favorable overall survival and progression-free survival rates were observed, with 5-year rates of 94.1% and 77.9% respectively. IDH mutational status emerged as the dominant independent prognostic factor. While no significant difference in progression-free survival was found between temozolomide and PCV in IDH-mutant patients, PCV was associated with higher hematologic toxicity and more dose modifications.
Analysis
This real-world study confirms the efficacy of current adjuvant treatments for high-risk grade 2 gliomas, emphasizing the significant prognostic importance of IDH status. It suggests that temozolomide could be a less toxic alternative to the PCV regimen without compromising efficacy in IDH-mutant patients, which is crucial for patient quality of life. These findings call for prospective, molecularly stratified trials to refine therapeutic recommendations and optimize the benefit-risk ratio.