Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial

Détails

ID Serval
serval:BIB_78213DAF0199
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial
Périodique
Lancet
Auteur(s)
van den Bent  M. J., Afra  D., de Witte  O., Ben Hassel  M., Schraub  S., Hoang-Xuan  K., Malmstrom  P. O., Collette  L., Pierart  M., Mirimanoff  R., Karim  A. B.
ISSN
1474-547X (Electronic)
Statut éditorial
Publié
Date de publication
09/2005
Volume
366
Numéro
9490
Pages
985-90
Notes
Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S. --- Old month value: Sep 17-23
Résumé
BACKGROUND: Postoperative policies of "wait-and-see" and radiotherapy for low-grade glioma are poorly defined. A trial in the mid 1980s established the radiation dose. In 1986 the EORTC Radiotherapy and Brain Tumor Groups initiated a prospective trial to compare early radiotherapy with delayed radiotherapy. An interim analysis has been reported. We now present the long-term results. METHODS: After surgery, patients from 24 centres across Europe were randomly assigned to either early radiotherapy of 54 Gy in fractions of 1.8 Gy or deferred radiotherapy until the time of progression (control group). Patients with low-grade astrocytoma, oligodendroglioma, mixed oligoastrocytoma, and incompletely resected pilocytic astrocytoma, with a WHO performance status 0-2 were eligible. Analysis was by intention to treat, and primary endpoints were overall and progression-free survival. FINDINGS: 157 patients were assigned early radiotherapy, and 157 control. Median progression-free survival was 5.3 years in the early radiotherapy group and 3.4 years in the control group (hazard ratio 0.59, 95% CI 0.45-0.77; p<0.0001). However, overall survival was similar between groups: median survival in the radiotherapy group was 7.4 years compared with 7.2 years in the control group (hazard ratio 0.97, 95% CI 0.71-1.34; p=0.872). In the control group, 65% of patients received radiotherapy at progression. At 1 year, seizures were better controlled in the early radiotherapy group. INTERPRETATION: Early radiotherapy after surgery lengthens the period without progression but does not affect overall survival. Because quality of life was not studied, it is not known whether time to progression reflects clinical deterioration. Radiotherapy could be deferred for patients with low-grade glioma who are in a good condition, provided they are carefully monitored.
Mots-clé
Adolescent Adult Aged Astrocytoma/mortality/*radiotherapy Central Nervous System Neoplasms/mortality/*radiotherapy Disease Progression Disease-Free Survival Female Humans Male Middle Aged Oligodendroglioma/mortality/*radiotherapy Radiotherapy Dosage Survival Rate
Pubmed
Web of science
Création de la notice
24/01/2008 18:12
Dernière modification de la notice
03/03/2018 18:29
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