Variations in the management of diffuse low-grade gliomas - A Scandinavian multicenter study
(2021) In Neuro-Oncology Practice 8(6). p.706-717- Abstract
Background: Early extensive surgery is a cornerstone in treatment of diffuse low-grade gliomas (DLGGs), and an additional survival benefit has been demonstrated from early radiochemotherapy in selected "high-risk"patients. Still, there are a number of controversies related to DLGG management. The objective of this multicenter population-based cohort study was to explore potential variations in diagnostic work-up and treatment between treating centers in 2 Scandinavian countries with similar public health care systems. Methods: Patients screened for inclusion underwent primary surgery of a histopathologically verified diffuse WHO grade II glioma in the time period 2012 through 2017. Clinical and radiological data were collected from... (More)
Background: Early extensive surgery is a cornerstone in treatment of diffuse low-grade gliomas (DLGGs), and an additional survival benefit has been demonstrated from early radiochemotherapy in selected "high-risk"patients. Still, there are a number of controversies related to DLGG management. The objective of this multicenter population-based cohort study was to explore potential variations in diagnostic work-up and treatment between treating centers in 2 Scandinavian countries with similar public health care systems. Methods: Patients screened for inclusion underwent primary surgery of a histopathologically verified diffuse WHO grade II glioma in the time period 2012 through 2017. Clinical and radiological data were collected from medical records and locally conducted research projects, whereupon differences between countries and inter-hospital variations were explored. Results: A total of 642 patients were included (male:female ratio 1:4), and annual age-standardized incidence rates were 0.9 and 0.8 per 100 000 in Norway and Sweden, respectively. Considerable inter-hospital variations were observed in preoperative work-up, tumor diagnostics, surgical strategies, techniques for intraoperative guidance, as well as choice and timing of adjuvant therapy. Conclusions: Despite geographical population-based case selection, similar health care organizations, and existing guidelines, there were considerable variations in DLGG management. While some can be attributed to differences in clinical implementation of current scientific knowledge, some of the observed inter-hospital variations reflect controversies related to diagnostics and treatment. Quantification of these disparities renders possible identification of treatment patterns associated with better or worse outcomes and may thus represent a step toward more uniform evidence-based care.
(Less)
- author
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- adjuvant, chemotherapy, diagnostic imaging, glioma, radiotherapy, surgical oncology
- in
- Neuro-Oncology Practice
- volume
- 8
- issue
- 6
- pages
- 12 pages
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85121127191
- pmid:34777840
- ISSN
- 2054-2577
- DOI
- 10.1093/nop/npab054
- language
- English
- LU publication?
- yes
- id
- e0f52f87-be92-4cde-baac-24844d30b6f8
- date added to LUP
- 2022-01-27 12:12:56
- date last changed
- 2024-06-16 00:39:21
@article{e0f52f87-be92-4cde-baac-24844d30b6f8,
abstract = {{<p>Background: Early extensive surgery is a cornerstone in treatment of diffuse low-grade gliomas (DLGGs), and an additional survival benefit has been demonstrated from early radiochemotherapy in selected "high-risk"patients. Still, there are a number of controversies related to DLGG management. The objective of this multicenter population-based cohort study was to explore potential variations in diagnostic work-up and treatment between treating centers in 2 Scandinavian countries with similar public health care systems. Methods: Patients screened for inclusion underwent primary surgery of a histopathologically verified diffuse WHO grade II glioma in the time period 2012 through 2017. Clinical and radiological data were collected from medical records and locally conducted research projects, whereupon differences between countries and inter-hospital variations were explored. Results: A total of 642 patients were included (male:female ratio 1:4), and annual age-standardized incidence rates were 0.9 and 0.8 per 100 000 in Norway and Sweden, respectively. Considerable inter-hospital variations were observed in preoperative work-up, tumor diagnostics, surgical strategies, techniques for intraoperative guidance, as well as choice and timing of adjuvant therapy. Conclusions: Despite geographical population-based case selection, similar health care organizations, and existing guidelines, there were considerable variations in DLGG management. While some can be attributed to differences in clinical implementation of current scientific knowledge, some of the observed inter-hospital variations reflect controversies related to diagnostics and treatment. Quantification of these disparities renders possible identification of treatment patterns associated with better or worse outcomes and may thus represent a step toward more uniform evidence-based care. </p>}},
author = {{Munkvold, Bodil Karoline Ravn and Solheim, Ole and Bartek, Jiri and Corell, Alba and De Dios, Eddie and Gulati, Sasha and Helseth, Eirik and Holmgren, Klas and Jensdottir, Margret and Lundborg, Mina and Mireles, Eduardo Erasmo Mendoza and Mahesparan, Ruby and Tveiten, Øystein Vesterli and Milos, Peter and Nittby Redebrandt, Henrietta and Pedersen, Lars Kjelsberg and Ramm-Pettersen, Jon and Sjöberg, Rickard L. and Sjögren, Björn and Sjåvik, Kristin and Smits, Anja and Tomasevic, Gregor and Vecchio, Tomás Gómez and Vik-Mo, Einar O. and Zetterling, Maria and Salvesen, Oyvind and Jakola, Asgeir S.}},
issn = {{2054-2577}},
keywords = {{adjuvant; chemotherapy; diagnostic imaging; glioma; radiotherapy; surgical oncology}},
language = {{eng}},
number = {{6}},
pages = {{706--717}},
publisher = {{Oxford University Press}},
series = {{Neuro-Oncology Practice}},
title = {{Variations in the management of diffuse low-grade gliomas - A Scandinavian multicenter study}},
url = {{http://dx.doi.org/10.1093/nop/npab054}},
doi = {{10.1093/nop/npab054}},
volume = {{8}},
year = {{2021}},
}