• Jing Wu, Natalie Neale, Yuqian Huang, Harrison X Bai, Xuejun Li, Zishu Zhang, Giorgos Karakousis, Raymond Huang, Paul J Zhang, Lei Tang, Bo Xiao, and Li Yang.
• Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
• World Neurosurg. 2018 Apr 1; 112: e812-e822.

BackgroundIt is becoming increasingly common to incorporate chemotherapy (CT) with radiotherapy (RT) in the treatment of low-grade gliomas (LGGs) after surgical resection. However, there is a lack of literature comparing survival of patients who underwent RT or CT alone.MethodsThe U.S. National Cancer Data Base was used to identify patients with histologically confirmed, World Health Organization grade 2 gliomas who received either RT alone or CT alone after surgery from 2004 to 2013. Overall survival (OS) was evaluated by Kaplan-Meier analysis, multivariable Cox proportional hazard regression, and propensity-score-matched analysis.ResultsIn total, 2253 patients with World Health Organization grade 2 gliomas were included, of whom 1466 (65.1%) received RT alone and 787 (34.9%) CT alone. The median OS was 98.9 months for the RT alone group and 125.8 months for the CT alone group. On multivariable analysis, CT alone was associated with a significant OS benefit compared with RT alone (hazard ratio [HR], 0.405; 95% confidence interval, 0.277-0.592; P < 0.001). On subgroup analyses, the survival advantage of CT alone over RT alone persisted across all age groups, and for the subtotal resection and biopsy groups, but not in the gross total resection group. In propensity-score-matched analysis, CT alone still showed significantly improved OS compared with RT alone (HR, 0.612; 95% confidence interval, 0.506-0.741; P < 0.001).ConclusionsOur results suggest that CT alone was independently associated with longer OS compared with RT alone in patients with LGGs who underwent surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

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