Should patients with low-grade gliomas have early radiotherapy after surgery?

For most patients with low-grade glioma (LGG), the main treatment is still postoperative radiotherapy.
, however, the best time for radiation therapy is still controversial, whether early postoperative radiation therapy or delay until the tumor progresses and then radiotherapy? Sanjay Dhawan of neurosurgery at the University of Minnesota, USA, and others analyzed the timing of radiotherapy after low-level gliomas through literature searches.
results were published online January 2020 in Cochrane Database of System Reviews.
Research Methods Researchers searched the relevant literature until September 2014, and from September 2014 to November 2019 searched and updated the literature in the following electronic databases: Central Registry of Cochrane Controlled Trials (CENTRAL; No. 11 of 2019), Ovid's MEDLINE (September 2014 to November 2, 2019) and Ovid's Embase (Week 46 of 2014-2019) are confirmed to be included in the update to the Cochrane review.
using randomized controlled trials (RCTs), comparing intracranial LGG for newly diagnosed intracranial radiotherapy and delayed radiotherapy after biopsy or surgical removal, including dispersive astrocytoma ( diffuse astrocytoma) and oligodendrogli the efficacy of mixed oligoastrocytoma, astroblastoma, yellow astroblastoma, yellow astrocytoma, or ganglioglioma.
radiation therapy, including linear accelerator or cobalt-60 in-body radiation therapy (EBRT), strength radiotherapy (IMRT), or stereotactic radiosurgery (SRS).
the results of the study, researchers screened more than 900 updated literature published over the past five years and carefully analyzed the quality of the literature and found that none of the updated articles from 2014 to 2019 met the criteria for inclusion in the study.
only one study, conducted in 2005, met the inclusion requirements.
the study was a large, multi-center, forward-looking randomized controlled clinical trial with 311 LGG patients; postoperative radiation therapy at 1.8Gy doses five times a week for 6 weeks; and a total dose of 54Gy.
results showed that the postoperative early radiation therapy group in LGG patients had significantly longer progression survival than the delayed radiotherapy group when the disease progressed, but did not significantly extend the total survival period (OS).
5.3 years for the medium non-progressed lifetime (PFS) in the early radiotherapy group and 3.4 years for the delayed radiotherapy group (HR=0.59; 95% CI, 0.45-0.77; P 0.0001).
OS in the early radiotherapy group was 7.4 years, while the medium OS in the delayed radiotherapy group was 7.2 years (HR s 0.97; 95% CI, 0.71-1.33; P s 0.872).
adverse reactions after radiation therapy, including skin reactions, otitis midotitis, mild headache, nausea and vomiting, were similar in both groups.
delayed radiotherapy is a rescue treatment for 65% of patients.
patients with no progression of tumors in the early radiotherapy group and the delayed radiotherapy group appeared to have no difference in cognitive impairment, symptoms and headache after one year.
, the frequency of seizures decreased significantly in patients in the early radiotherapy group compared to those in the delayed radiotherapy group (25%: 41% ;P x 0.0329).
Conclusions The authors conclude that for patients with low-grade gliomas, early postoperative radiotherapy may benefit patients.
the study has a high risk of bias, so be careful about understanding the results.
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