Watch-and-wait approach versus adjuvant treatment after radical awake resection in selected adult-type grade 3 gliomas, isocitrate dehydrogenase mutant: A case-matched cohort

Angela Elia; Alexandre Roux; Bénédicte Trancart; Alessandro Moiraghi; Maimiti Seneca; Edouard Dezamis; Pascale Varlet; Fabrice Chretien; Catherine Oppenheim; Marc Zanello; Johan Pallud

doi:10.1093/noajnl/vdae189

Watch-and-wait approach versus adjuvant treatment after radical awake resection in selected adult-type grade 3 gliomas, isocitrate dehydrogenase mutant: A case-matched cohort

Neurooncol Adv. 2024 Nov 18;6(1):vdae189. doi: 10.1093/noajnl/vdae189. eCollection 2024 Jan-Dec.

Authors

Angela Elia¹, Alexandre Roux¹, Bénédicte Trancart^{1

2}, Alessandro Moiraghi^{3

1

2}, Maimiti Seneca¹, Edouard Dezamis^{1

2}, Pascale Varlet^{4

3}, Fabrice Chretien^{3

1}, Catherine Oppenheim^{5

1}, Marc Zanello^{3

1}, Johan Pallud^{1

2}

Affiliations

¹ Faculté de Médecine, Université Paris Cité, Paris, France.
² Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences - Sainte-Anne Hospital, Paris, France.
³ Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
⁴ Department of Neuropathology, GHU Paris Psychiatrie et Neurosciences - Sainte-Anne Hospital, Paris, France.
⁵ Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences - Sainte-Anne Hospital, Paris, France.

Abstract

Background: Following large resection, proposing a watch-and-wait strategy in selected grade 3 glioma, isocitrate dehydrogenase (IDH)-mutant patients is an emerging practice. We compared the watch-and-wait approach to the standard postoperative adjuvant oncological treatment for grade 3 gliomas, IDH-mutant.

Methods: Observational, retrospective, single-institution cohort (2011-2023) of 106 consecutive adult patients harboring supratentorial grade 3 gliomas, IDH-mutant treated by maximal awake resection and who received a watch-and-wait approach (surgery group) or an adjuvant oncological treatment (oncological group) postoperatively. Case-matched analysis (1:1) criteria between the surgery group and oncological group: extent of resection, tumor volume, Karnofsky Performance Status (KPS) score, tumor location and size, and age.

Results: Patients of the surgery group (n = 26) had significantly better KPS scores, less preoperative neurological and/or neurocognitive deficits, less hyperperfusion, less corpus callosum infiltration, smaller tumor volume, higher rate of total resection, and smaller residual tumor than patients of the oncological group (n = 80). The 5-year progression-free survival (66.2 vs. 77.9 months, P = .713) and the 5-year overall survival (88.9 vs. 83.9 months, P = .291) did not differ between surgery and oncological groups. In the whole series, a preoperative KPS score >70, a total resection, and the oligodendroglioma subtype were independent predictors of longer progression-free survival and overall survival. After case matching, no difference in survival was observed between watch-and-wait and oncological treatment both in astrocytomas (n = 14 per group) and oligodendrogliomas (n = 12 per group).

Conclusions: Watch-and-wait following radical resection appears to be feasible in highly selected grade 3 gliomas, IDH-mutant patients without impairing survival both in astrocytoma and in oligodendroglioma subgroups.

Keywords: awake surgery; grade 3 glioma; radiotherapy; survival; watch-and-wait.