Role of immediate versus deferred radiotherapy in good prognostic post-operative histologically proved low grade gliomas
immediate versus deferred radiotherapy in low grade gliomas
Purpose : The aim of our prospective study was to compare the role of immediate radiotherapy with delayed radiation therapy in good prognostic low grade gliomas.
Material and methods: A total of 30 patients of low grade glioma ( grade I,II) with good prognostic features like tumor size <5 cm not crossing midline, no neurological deficit, KPS >70, young patients<40 years old were divided into two groups A and B of 15 each. One group received radiotherapy immediately after surgery as post -operative adjuvant therapy and second group of patients were observed for any symptomatic deterioration and evidence of progressive disease on serial MRI done every 3 months. The data was analysed in terms of age, sex, site of tumor, tolerance, toxicity, survival and inference was drawn.
Results : the two groups were matched in age and sex distribution ( mean age 32.6 years and 30.3 years respectively ). 86.7 % in group A and 60 % in group B were males. The chief complaints were seizures and headache in both the groups (86.7% and 80% respectively). The location of tumor in the frontal region was more common ( 26.7% in group A and 33.3% in group B). Majority of the patients were able to underwent gross tumor resection and decompression (93.3% in both groups). Both the groups were equally matched in terms of duration of symptoms >6 months or < 6 months (53.3% in group A and 46.7% in group B. Among the group B who were kept under observation , 5 (33.3%) patients got radiotherapy in view of progressive disease. At the end of 2 years 93.35% patients were alive in both groups. Majority of the patients tolerated radiation therapy well with mild symptoms like loss of appetite, dyspepsia,headache.
Conclusion : our results showed that delayed radiotherapy with wait and watch concept may be an option with close monitoring in good prognostic completely resected low grade gliomas. Large randomized clinical trial with longer follow up is necessary to clarify these issues to determine a consistent policy.
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