Radiotherapy in low-grade gliomas: Cons

Détails

ID Serval
serval:BIB_DBCDE5CDE28B
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Radiotherapy in low-grade gliomas: Cons
Périodique
Seminars in Oncology
Auteur(s)
Mirimanoff  R. O., Stupp  R.
ISSN
0093-7754 (Print)
Statut éditorial
Publié
Date de publication
12/2003
Volume
30
Numéro
6 Suppl 19
Pages
34-8
Notes
Comment
Journal Article
Review --- Old month value: Dec
Résumé
Although postoperative radiotherapy (RT) is widely used in patients with low-grade gliomas (LGGs), its clinical benefit remains unproven. Because LGGs include diseases with many different histologies, cytogenetic patterns, and natural histories, evaluating the effect of any treatment for LGGs is difficult. Analysis of prognostic subgroups has shown median survival rates ranging from 1 to 10 years. The clinical benefit of postoperative RT in LGGs in retrospective studies is confounded by the heterogeneity of LGGs and treatment-related variables. These studies report conflicting results, most likely because of differences in patient populations. The only prospective, randomized trial comparing postoperative RT with observation failed to show a survival benefit but showed a modest, although statistically significant, improvement in time to progression. Given that two thirds of patients in the observation group received RT at progression, the absence of a survival benefit suggests that RT is active in LGGs, but that delayed RT may provide the same survival advantage as postoperative RT. Moreover, high-dose or whole-brain RT can cause cognitive deficits. Our opinion is that postoperative RT should not be administered routinely to patients with LGGs. If RT is deemed necessary, such as in progressive or inoperable disease causing neurologic symptoms, a total dose of </=50 Gy with a fractional dose of </=1.8 to 2 Gy should be administered using modern, highly conformal techniques. Ideally, RT should be used only within the context of clinical research protocols.
Mots-clé
Brain Neoplasms/mortality/pathology/*radiotherapy/surgery Glioma/mortality/pathology/*radiotherapy/surgery Humans Patient Selection Quality of Life Radiotherapy, Adjuvant/adverse effects Survival Rate
Pubmed
Web of science
Création de la notice
28/01/2008 8:39
Dernière modification de la notice
20/08/2019 16:00
Données d'usage