Vroeg gestarte bestraling - radiotherapie bij laaggradige hersentumoren geeft geen positief effect op mediane overlevingstijd indien vergeleken met afwachten tot behandelen (wait and see) maar geeft wel significant positief effect op ziektevrije tijd

5 juli 2009: Bron: 1: Lancet. 2005 Sep 17-23;366(9490):985-90.

Vroeg gestarte bestraling - radiotherapie bij laaggradige hersentumoren geeft geen positief effect op mediane overlevingstijd indien vergeleken met afwachten tot behandelen (wait and see beleid) maar geeft wel significant positief verschil in ziektevrije tijd tot een recidief optreedt of tot een laaggradige tumor hooggradig wordt. Aldus een gerandomiseerde fase III studie onder leiding van prof. van den Bent en gepubliceerd in The Lancet al in 2006. De vraag is nog steeds of radiotherpaie zinvol is of dat het wachten zinvol is en welke van de twee opties van doorslaggevende invloed kan zijn op de kwaliteit van leven.

RESULTATEN: 157 patienten werden behandeld met vroege radiotherapie, en bij 157 in controlegroep was gewacht tot zich teveel kalchten voordeden. Mediane ziektevrije tijd was 5.3 jaar in de vroege radiotherapie groep en 3,4 jaar in de controle groep (hazard ratio 0.59, 95% CI 0.45-0.77; p<0.0001). Echter, overall overlevingstijd was gelijk tussen de groepen: mediane overlevingstijd in de vroege radiotherapie groep was 7.4 jaar tegenover 7.2 jaar in de controle groep (hazard ratio 0.97, 95% CI 0.71-1.34; p=0.872). In de controle groep, kreeg 65% van de patienten radiotherapie bij progressie van de ziekte. Op 1 jaars meting waren de metingen beter in de vroege bestralingsgroep.

Erratum in:

Lancet. 2006 Jun 3;367(9525):1818.
Comment in:: Lancet Oncol. 2005 Dec;6(12):921; author reply 922.

Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial.

van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmström PO, Collette L, Piérart M, Mirimanoff R, Karim AB; EORTC Radiotherapy and Brain Tumor Groups and the UK Medical Research Council.

Erasmus Medical Centrum Daniel den Hoed Oncology Center, Rotterdam. m.vandenbent@erasmusmc.nl

BACKGROUND: Postoperative policies of "wait-and-see" and radiotherapy for low-grade glioma are poorly defined. A trial in the mid 1980s established the radiation dose. In 1986 the EORTC Radiotherapy and Brain Tumor Groups initiated a prospective trial to compare early radiotherapy with delayed radiotherapy. An interim analysis has been reported. We now present the long-term results.

METHODS: After surgery, patients from 24 centres across Europe were randomly assigned to either early radiotherapy of 54 Gy in fractions of 1.8 Gy or deferred radiotherapy until the time of progression (control group). Patients with low-grade astrocytoma, oligodendroglioma, mixed oligoastrocytoma, and incompletely resected pilocytic astrocytoma, with a WHO performance status 0-2 were eligible. Analysis was by intention to treat, and primary endpoints were overall and progression-free survival.

FINDINGS: 157 patients were assigned early radiotherapy, and 157 control. Median progression-free survival was 5.3 years in the early radiotherapy group and 3.4 years in the control group (hazard ratio 0.59, 95% CI 0.45-0.77; p<0.0001). However, overall survival was similar between groups: median survival in the radiotherapy group was 7.4 years compared with 7.2 years in the control group (hazard ratio 0.97, 95% CI 0.71-1.34; p=0.872). In the control group, 65% of patients received radiotherapy at progression. At 1 year, seizures were better controlled in the early radiotherapy group.

INTERPRETATION: Early radiotherapy after surgery lengthens the period without progression but does not affect overall survival. Because quality of life was not studied, it is not known whether time to progression reflects clinical deterioration. Radiotherapy could be deferred for patients with low-grade glioma who are in a good condition, provided they are carefully monitored.

PMID: 16168780 [PubMed - indexed for MEDLINE]

wait and see, progressie, ziektevrije tijd, hersentumoren, laaggradige gliomas, radiotherapie