Abstract BACKGROUND Two adult-type diffuse gliomas include IDH-mutant astrocytomas and IDH-mutant, 1p/19q-codeleted oligodendrogliomas. After maximal safe resection, patients undergo either a watch-and-wait strategy or upfront treatment with radiotherapy and chemotherapy. This study examined patient and tumour factors influencing clinical decision-making and outcomes. METHODS Patients with grade 2 gliomas resected between January 2012 and December 2022 were retrospectively reviewed. Demographics, tumour characteristics, and treatment details were collected to identify factors influencing initial decisions and survival. Physician consultation notes and tumour board discussions were reviewed to provide descriptive context for clinical decisions. Kaplan-Meier survival analyses were performed, with comparisons using log-rank tests (p 0.05). RESULTS To date, 100 eligible patients have been identified. Key patient factors influencing clinical decisions included age 40 (48% watch-and-wait vs. 61% upfront treatment) and pre-surgical neurological symptoms (94% vs. 100%). Tumour factors included histology (62% vs. 46%), size 6 cm (23% vs. 39%), Ki67 (35% vs. 24%), MRI evidence of midline crossing (2% vs. 13%, p 0.05), residual tumour (71% vs. 91%, p 0.05), and contrast enhancement (13% vs. 33%, p 0.05). mPFS was 5.0 years in the watch-and-wait vs. NR in the upfront treatment group. mOS was not reached in either group. CONCLUSION Patient and tumour factors play a critical role in clinical decision-making. MRI findings such as midline crossing, residual tumour, and contrast enhancement were significantly associated with treatment strategies. These findings highlight their importance in managing grade 2 gliomas, particularly as the treatment landscape continues to evolve with vorasidenib. ACKNOWLEDGEMENTS: Biennial Canadian Neuro-Oncology Meeting www.cnomeeting.ca AWARDS provided by: Brain Tumour Foundation of Canada www.braintumour.ca Brain Cancer Canada www.braincancercanada.ca BC Cancer Foundation https://bccancerfoundation.com
Lee et al. (Fri,) studied this question.
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