Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.

<h4>Background</h4>Surgical management of suspected LGG remains controversial. A key factor when deciding a surgical strategy is often the tumors' perceived relationship to eloquent brain regions<h4>Objective</h4>To study the association between tumor location, survival...

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Autores principales:	Asgeir S Jakola, Geirmund Unsgård, Kristin S Myrmel, Roar Kloster, Sverre H Torp, Sigurd Lindal, Ole Solheim
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f1ab5dd6f6944e519702bd36220176ae
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spelling	oai:doaj.org-article:f1ab5dd6f6944e519702bd36220176ae2021-11-18T08:05:43ZLow grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.1932-620310.1371/journal.pone.0051450https://doaj.org/article/f1ab5dd6f6944e519702bd36220176ae2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23251537/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Surgical management of suspected LGG remains controversial. A key factor when deciding a surgical strategy is often the tumors' perceived relationship to eloquent brain regions<h4>Objective</h4>To study the association between tumor location, survival and long-term health related quality of life (HRQL) in patients with supratentorial low-grade gliomas (LGG).<h4>Methods</h4>Adults (≥18 years) operated due to newly diagnosed LGG from 1998 through 2009 included from two Norwegian university hospitals. After review of initial histopathology, 153 adults with supratentorial WHO grade II LGG were included in the study. Tumors' anatomical location and the relationship to eloquent regions were graded. Survival analysis was adjusted for known prognostic factors and the initial surgical procedure (biopsy or resection). In long-term survivors, HRQL was assessed with disease specific questionnaires (EORTC QLQ-C30 and BN20) as well as a generic questionnaire (EuroQol 5D).<h4>Results</h4>There was a significant association between eloquence and survival (log-rank, p<0.001). The estimated 5-year survival was 77% in non-eloquent tumors, 71% in intermediate located tumors and 54% in eloquent tumors. In the adjusted analysis the hazard ratio of increasing eloquence was 1.5 (95% CI 1.1-2.0, p = 0.022). There were no differences in HRQL between patients with eloquent and non-eloquent tumors. The most frequent self-reported symptoms were related to fatigue, cognition, and future uncertainty.<h4>Conclusion</h4>Eloquently located LGGs are associated with impaired survival compared to non-eloquently located LGG, but in long-term survivors HRQL is similar. Although causal inference from observational data should be done with caution, the findings illuminate the delicate balance in surgical decision making in LGGs, and add support to the probable survival benefits of aggressive surgical strategies, perhaps also in eloquent locations.Asgeir S JakolaGeirmund UnsgårdKristin S MyrmelRoar KlosterSverre H TorpSigurd LindalOle SolheimPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e51450 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Asgeir S Jakola Geirmund Unsgård Kristin S Myrmel Roar Kloster Sverre H Torp Sigurd Lindal Ole Solheim Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
description	<h4>Background</h4>Surgical management of suspected LGG remains controversial. A key factor when deciding a surgical strategy is often the tumors' perceived relationship to eloquent brain regions<h4>Objective</h4>To study the association between tumor location, survival and long-term health related quality of life (HRQL) in patients with supratentorial low-grade gliomas (LGG).<h4>Methods</h4>Adults (≥18 years) operated due to newly diagnosed LGG from 1998 through 2009 included from two Norwegian university hospitals. After review of initial histopathology, 153 adults with supratentorial WHO grade II LGG were included in the study. Tumors' anatomical location and the relationship to eloquent regions were graded. Survival analysis was adjusted for known prognostic factors and the initial surgical procedure (biopsy or resection). In long-term survivors, HRQL was assessed with disease specific questionnaires (EORTC QLQ-C30 and BN20) as well as a generic questionnaire (EuroQol 5D).<h4>Results</h4>There was a significant association between eloquence and survival (log-rank, p<0.001). The estimated 5-year survival was 77% in non-eloquent tumors, 71% in intermediate located tumors and 54% in eloquent tumors. In the adjusted analysis the hazard ratio of increasing eloquence was 1.5 (95% CI 1.1-2.0, p = 0.022). There were no differences in HRQL between patients with eloquent and non-eloquent tumors. The most frequent self-reported symptoms were related to fatigue, cognition, and future uncertainty.<h4>Conclusion</h4>Eloquently located LGGs are associated with impaired survival compared to non-eloquently located LGG, but in long-term survivors HRQL is similar. Although causal inference from observational data should be done with caution, the findings illuminate the delicate balance in surgical decision making in LGGs, and add support to the probable survival benefits of aggressive surgical strategies, perhaps also in eloquent locations.
format	article
author	Asgeir S Jakola Geirmund Unsgård Kristin S Myrmel Roar Kloster Sverre H Torp Sigurd Lindal Ole Solheim
author_facet	Asgeir S Jakola Geirmund Unsgård Kristin S Myrmel Roar Kloster Sverre H Torp Sigurd Lindal Ole Solheim
author_sort	Asgeir S Jakola
title	Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
title_short	Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
title_full	Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
title_fullStr	Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
title_full_unstemmed	Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
title_sort	low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/f1ab5dd6f6944e519702bd36220176ae
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Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life.

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