Low tumour burden is associated with observation after surgery in patients with grade 2 astrocytoma and oligodendroglioma: results from the prospective multicentre LoG-Glio registry

Recent evidence-based guidelines recommend adjuvant therapy following surgery for most patients with WHO grade 2 and 3 gliomas. However, deviations from these recommendations are frequently observed in clinical practice. This study aimed to evaluate patterns of postoperative management across Germany, using multicentre registry data from certified neuro-oncology centres. We analysed data from the ongoing multicentre registry study, which prospectively collects adult patients with IDH-mutant WHO grade 2 and 3 diffuse gliomas. Patients treated at 14 certified neuro-oncology centres were included. Multivariate logistic regression was used to identify factors associated with observation, chemotherapy, or radiotherapy. We assessed concordance between guideline recommendations and actual treatment during the first year after surgery. A total of 217 patients with astrocytoma or oligodendroglioma were included, of whom 169 (78%) had WHO grade 2 tumours. Observation alone was selected in 90 (53%) patients with grade 2 tumours. Gross total resection was independently associated with observation (OR 0.10; 95% CI, 0.04–0.22; p < 0.001). In patients aged ≥ 40 years, adjuvant treatment decisions deviated from current guidelines (OR 3.15; 95% CI, 1.70–5.95; p = 0.001), although age itself was not an independent predictor of treatment choice in multivariate models. The presence of residual tumour after surgery was the principal determinant of postoperative management in patients with WHO grade 2 gliomas. Age ≥ 40 years did not independently influence clinical decision-making. These findings highlight a gap between guidelines and real-world practice and underscore the need for more flexible, individualised treatment frameworks.

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Publication Details

Journal
Journal of Neuro-Oncology
Published
2025-10-15
DOI
https://doi.org/10.1007/s11060-025-05279-4
Primary Topic
Glioma Diagnosis and Treatment
Type
article
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article

Low tumour burden is associated with observation after surgery in patients with grade 2 astrocytoma and oligodendroglioma: results from the prospective multicentre LoG-Glio registry

Peter Vajkoczy, Sandro M. Krieg, Jan Coburger, Katja Kniese et al.
Journal of Neuro-Oncology
Glioma Diagnosis and Treatment
article

Low tumour burden is associated with observation after surgery in patients with grade 2 astrocytoma and oligodendroglioma: results from the prospective multicentre LoG-Glio registry

Peter Vajkoczy, Sandro M. Krieg, Jan Coburger, Katja Kniese, Stefan Rückriegel, Sebastian Ille, Oliver Ganslandt, Nicolas Neidert, Rainer Ritz, Constantin Roder, Christian Rainer Wirtz, Veit Rohde, Marcos Soares Tatagiba, Minou Nadji‐Ohl, Daniel Sachs, Ralf‐Ingo Ernestus, Lennart W. Sannwald, Benjamin Mayer, Andreas Ziebart, S Riehl, Julia Onken, Marcus Czabanka, Roland Roelz, Darius Kalasauskas, Florian Ringel, Jürgen Beck, Dorothée Mielke, Marie-Thérèse Forster, Ludovica Fabbrocini, Florian H. Ebner, Mario Löhr, Arya Nabavi, Rüdiger Gerlach, G Aziz
article en

Abstract

Recent evidence-based guidelines recommend adjuvant therapy following surgery for most patients with WHO grade 2 and 3 gliomas. However, deviations from these recommendations are frequently observed in clinical practice. This study aimed to evaluate patterns of postoperative management across Germany, using multicentre registry data from certified neuro-oncology centres. We analysed data from the ongoing multicentre registry study, which prospectively collects adult patients with IDH-mutant WHO grade 2 and 3 diffuse gliomas. Patients treated at 14 certified neuro-oncology centres were included. Multivariate logistic regression was used to identify factors associated with observation, chemotherapy, or radiotherapy. We assessed concordance between guideline recommendations and actual treatment during the first year after surgery. A total of 217 patients with astrocytoma or oligodendroglioma were included, of whom 169 (78%) had WHO grade 2 tumours. Observation alone was selected in 90 (53%) patients with grade 2 tumours. Gross total resection was independently associated with observation (OR 0.10; 95% CI, 0.04–0.22; p < 0.001). In patients aged ≥ 40 years, adjuvant treatment decisions deviated from current guidelines (OR 3.15; 95% CI, 1.70–5.95; p = 0.001), although age itself was not an independent predictor of treatment choice in multivariate models. The presence of residual tumour after surgery was the principal determinant of postoperative management in patients with WHO grade 2 gliomas. Age ≥ 40 years did not independently influence clinical decision-making. These findings highlight a gap between guidelines and real-world practice and underscore the need for more flexible, individualised treatment frameworks.

Journal of Neuro-OncologyVol. 176(1)
Goethe University Frankfurt (DE), University of Applied Sciences Mainz (DE), Zimmer Biomet (Netherlands) (NL), Universität Ulm (DE), Johannes Gutenberg University Mainz (DE), Heidelberg University (DE), University of Würzburg (DE), University Medical Center Freiburg (DE), University Hospital Augsburg (DE), University Hospital Heidelberg (DE), Klinikum Region Hannover (DE), Universitätsmedizin Göttingen (DE), University Hospital Frankfurt (DE), Schwarzwald-Baar Klinikum (DE), Helios Klinikum Erfurt (DE), Alfried Krupp Hospital (DE), University Hospital Ulm (DE), Klinikum Stuttgart (DE), Frankfurt University of Applied Sciences (DE), University of Göttingen (DE), Charité - Universitätsmedizin Berlin (DE), University of Tübingen (DE), Ludwig-Maximilians-Universität München (DE), Heidelberg University (US)
Openalex Percentile: Top 59%
Glioma Diagnosis and Treatment
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