• Stefan J Grau, Juergen A Hampl, Ann-Cathrin Kohl, Marco Timmer, Inga V Duval, Tobias Blau, Maximilian I Ruge, and Roland H Goldbrunner.
• Department of Neurosurgery, University of Cologne, Cologne, Germany. Electronic address: stefan.grau@uk-koeln.de.
• World Neurosurg. 2017 Jul 1; 103: 180-185.

ObjectiveTo evaluate the impact of surgical resection and adjuvant treatment on the course of patients after malignant progression of previously treated isocitrate dehydrogenase 1 (IDH1)-mutated World Health Organization (WHO) grade II astrocytoma.MethodsThis retrospective study explored 56 patients undergoing tumor resection for malignant progression after previously treated IDH1-mutated WHO grade II astrocytoma. We analyzed survival after malignant progression, analyzed overall survival (OS), and identified prognostic factors using Kaplan-Meier estimates and log-rank test.ResultsBy the time of malignant transformation, median age was 44 years, and median Karnofsky Performance Status (KPS) score was 90. Complete resection of contrast-enhancing tissue was achieved in 18 (32.1%) patients. Median survival after re-resection was 33 months (95% confidence interval [CI], 20-46); median OS was 123 months (95% CI, 77-170). Gross total tumor resection, postoperative KPS score ≥80, adjuvant radiochemotherapy, and prior radiotherapy significantly correlated with post-malignant progression survival.ConclusionsPatients in good clinical condition with malignant progression of previously treated low-grade gliomas should receive aggressive treatment, including re-resection.Copyright © 2017 Elsevier Inc. All rights reserved.

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