Risk Factors for Malignant Transformation of Low-Grade Glioma
The incidence, risk factors, and outcomes of low-grade glioma patients who undergo malignant transformation (MT) in the era of temozolomide are not well known. This study evaluates these factors in a large group of World Health Organization grade 2 glioma patients treated at a tertiary-care institut...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2018-03, Vol.100 (4), p.965-971 |
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| creator | Murphy, Erin S. Leyrer, Charles M. Parsons, Michael Suh, John H. Chao, Samuel T. Yu, Jennifer S. Kotecha, Rupesh Jia, Xuefei Peereboom, David M. Prayson, Richard A. Stevens, Glen H.J. Barnett, Gene H. Vogelbaum, Michael A. Ahluwalia, Manmeet S. |
| description | The incidence, risk factors, and outcomes of low-grade glioma patients who undergo malignant transformation (MT) in the era of temozolomide are not well known. This study evaluates these factors in a large group of World Health Organization grade 2 glioma patients treated at a tertiary-care institution.
Patient, tumor, and treatment factors were analyzed using an institutional review board–approved low-grade glioma database. Characteristics were compared using χ2 and Wilcoxon signed rank tests. Time to event was summarized using proportional hazards models. Univariate and multivariate survival analyses were performed.
Of a total of 599 patients, 124 underwent MT; 76 (61.3%) had biopsy-proven MT. The MT incidence was 21%, and the median time to MT was 56.4 months. The 5- and 10-year progression-free survival rates were 30.6% ± 4.2% and 4.8% ± 1.9%, respectively, for MT patients and 60% ± 2.4% and 38% ± 2.7%, respectively, for non-MT patients. The 5- and 10-year overall survival rates were 75% ± 4.0% and 46% ± 5.0%, respectively, for MT patients and 87% ± 1.7% and 78% ± 2.3%, respectively, for non-MT patients. On multivariate analysis, older age (P = .001), male sex (P = .004), multiple tumor locations (P = .004), chemotherapy alone (P = .012), and extent of resection (P = .045) remained significant predictors of MT.
MT affects survival. Risk factors include older age, male sex, multiple tumor locations, use of chemotherapy alone, and presence of residual disease. Our finding that initial interventions could affect the rate of MT is provocative, but these data should be validated using data from prospective trials. In addition to improving survival, future therapeutic efforts should focus on preventing MT. |
| doi_str_mv | 10.1016/j.ijrobp.2017.12.258 |
| format | Article |
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Patient, tumor, and treatment factors were analyzed using an institutional review board–approved low-grade glioma database. Characteristics were compared using χ2 and Wilcoxon signed rank tests. Time to event was summarized using proportional hazards models. Univariate and multivariate survival analyses were performed.
Of a total of 599 patients, 124 underwent MT; 76 (61.3%) had biopsy-proven MT. The MT incidence was 21%, and the median time to MT was 56.4 months. The 5- and 10-year progression-free survival rates were 30.6% ± 4.2% and 4.8% ± 1.9%, respectively, for MT patients and 60% ± 2.4% and 38% ± 2.7%, respectively, for non-MT patients. The 5- and 10-year overall survival rates were 75% ± 4.0% and 46% ± 5.0%, respectively, for MT patients and 87% ± 1.7% and 78% ± 2.3%, respectively, for non-MT patients. On multivariate analysis, older age (P = .001), male sex (P = .004), multiple tumor locations (P = .004), chemotherapy alone (P = .012), and extent of resection (P = .045) remained significant predictors of MT.
MT affects survival. Risk factors include older age, male sex, multiple tumor locations, use of chemotherapy alone, and presence of residual disease. Our finding that initial interventions could affect the rate of MT is provocative, but these data should be validated using data from prospective trials. In addition to improving survival, future therapeutic efforts should focus on preventing MT.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2017.12.258</identifier><identifier>PMID: 29485076</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Analysis of Variance ; Antineoplastic Agents - adverse effects ; Antineoplastic Agents - therapeutic use ; Antineoplastic Agents, Alkylating - adverse effects ; Brain Neoplasms - epidemiology ; Brain Neoplasms - mortality ; Brain Neoplasms - pathology ; Brain Neoplasms - therapy ; Cell Transformation, Neoplastic - pathology ; Chi-Square Distribution ; Child ; Child, Preschool ; EARTH PLANET ; Female ; Glioma - epidemiology ; Glioma - mortality ; Glioma - pathology ; Glioma - therapy ; GLIOMAS ; Glycosides ; HAZARDS ; Humans ; Incidence ; Infant ; Lignans ; Male ; Middle Aged ; PATIENTS ; Progression-Free Survival ; RADIOLOGY AND NUCLEAR MEDICINE ; Risk Factors ; Sex Factors ; Statistics, Nonparametric ; Temozolomide - adverse effects ; Time Factors ; Young Adult</subject><ispartof>International journal of radiation oncology, biology, physics, 2018-03, Vol.100 (4), p.965-971</ispartof><rights>2017</rights><rights>Copyright © 2017. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-f6fb4da281c9730a5e6e1905d1d669e78565c62f1aa0e7662c999312103fbdd83</citedby><cites>FETCH-LOGICAL-c456t-f6fb4da281c9730a5e6e1905d1d669e78565c62f1aa0e7662c999312103fbdd83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2017.12.258$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,782,786,887,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29485076$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/23082801$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Murphy, Erin S.</creatorcontrib><creatorcontrib>Leyrer, Charles M.</creatorcontrib><creatorcontrib>Parsons, Michael</creatorcontrib><creatorcontrib>Suh, John H.</creatorcontrib><creatorcontrib>Chao, Samuel T.</creatorcontrib><creatorcontrib>Yu, Jennifer S.</creatorcontrib><creatorcontrib>Kotecha, Rupesh</creatorcontrib><creatorcontrib>Jia, Xuefei</creatorcontrib><creatorcontrib>Peereboom, David M.</creatorcontrib><creatorcontrib>Prayson, Richard A.</creatorcontrib><creatorcontrib>Stevens, Glen H.J.</creatorcontrib><creatorcontrib>Barnett, Gene H.</creatorcontrib><creatorcontrib>Vogelbaum, Michael A.</creatorcontrib><creatorcontrib>Ahluwalia, Manmeet S.</creatorcontrib><title>Risk Factors for Malignant Transformation of Low-Grade Glioma</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>The incidence, risk factors, and outcomes of low-grade glioma patients who undergo malignant transformation (MT) in the era of temozolomide are not well known. This study evaluates these factors in a large group of World Health Organization grade 2 glioma patients treated at a tertiary-care institution.
Patient, tumor, and treatment factors were analyzed using an institutional review board–approved low-grade glioma database. Characteristics were compared using χ2 and Wilcoxon signed rank tests. Time to event was summarized using proportional hazards models. Univariate and multivariate survival analyses were performed.
Of a total of 599 patients, 124 underwent MT; 76 (61.3%) had biopsy-proven MT. The MT incidence was 21%, and the median time to MT was 56.4 months. The 5- and 10-year progression-free survival rates were 30.6% ± 4.2% and 4.8% ± 1.9%, respectively, for MT patients and 60% ± 2.4% and 38% ± 2.7%, respectively, for non-MT patients. The 5- and 10-year overall survival rates were 75% ± 4.0% and 46% ± 5.0%, respectively, for MT patients and 87% ± 1.7% and 78% ± 2.3%, respectively, for non-MT patients. On multivariate analysis, older age (P = .001), male sex (P = .004), multiple tumor locations (P = .004), chemotherapy alone (P = .012), and extent of resection (P = .045) remained significant predictors of MT.
MT affects survival. Risk factors include older age, male sex, multiple tumor locations, use of chemotherapy alone, and presence of residual disease. Our finding that initial interventions could affect the rate of MT is provocative, but these data should be validated using data from prospective trials. In addition to improving survival, future therapeutic efforts should focus on preventing MT.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Antineoplastic Agents, Alkylating - adverse effects</subject><subject>Brain Neoplasms - epidemiology</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - therapy</subject><subject>Cell Transformation, Neoplastic - pathology</subject><subject>Chi-Square Distribution</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>EARTH PLANET</subject><subject>Female</subject><subject>Glioma - epidemiology</subject><subject>Glioma - mortality</subject><subject>Glioma - pathology</subject><subject>Glioma - therapy</subject><subject>GLIOMAS</subject><subject>Glycosides</subject><subject>HAZARDS</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Lignans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>PATIENTS</subject><subject>Progression-Free Survival</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Statistics, Nonparametric</subject><subject>Temozolomide - adverse effects</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMGKFDEQhoMo7uzqG4g0ePHSbVW6k04OCrK4ozAiyAreQiap1ozdnTHpUXz7zdCrR08FxffXX3yMPUNoEFC-OjThkOL-2HDAvkHecKEesA2qXtetEF8fsg20Euq2wBfsMucDACD23WN2wXWnBPRyw15_DvlHdWPdElOuhpiqj3YM32Y7L9VtsnMuq8kuIc5VHKpd_F1vk_VUbccQJ_uEPRrsmOnp_bxiX27e3V6_r3efth-u3-5q1wm51IMc9p23XKHTfQtWkCTUIDx6KTX1SkjhJB_QWqBeSu601i1yhHbYe6_aK_ZivRvzEkx2YSH33cV5JrcY3oLiCrBQL1fqmOLPE-XFTCE7Gkc7UzxlwwGU0sUCL2i3oi7FnBMN5pjCZNMfg2DOes3BrHrNWa9BboreEnt-33DaT-T_hf76LMCbFaBi41egdH6WZkc-pPOvPob_N9wB6TSLcA</recordid><startdate>20180315</startdate><enddate>20180315</enddate><creator>Murphy, Erin S.</creator><creator>Leyrer, Charles M.</creator><creator>Parsons, Michael</creator><creator>Suh, John H.</creator><creator>Chao, Samuel T.</creator><creator>Yu, Jennifer S.</creator><creator>Kotecha, Rupesh</creator><creator>Jia, Xuefei</creator><creator>Peereboom, David M.</creator><creator>Prayson, Richard A.</creator><creator>Stevens, Glen H.J.</creator><creator>Barnett, Gene H.</creator><creator>Vogelbaum, Michael A.</creator><creator>Ahluwalia, Manmeet S.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20180315</creationdate><title>Risk Factors for Malignant Transformation of Low-Grade Glioma</title><author>Murphy, Erin S. ; Leyrer, Charles M. ; Parsons, Michael ; Suh, John H. ; Chao, Samuel T. ; Yu, Jennifer S. ; Kotecha, Rupesh ; Jia, Xuefei ; Peereboom, David M. ; Prayson, Richard A. ; Stevens, Glen H.J. ; Barnett, Gene H. ; Vogelbaum, Michael A. ; Ahluwalia, Manmeet S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-f6fb4da281c9730a5e6e1905d1d669e78565c62f1aa0e7662c999312103fbdd83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Antineoplastic Agents, Alkylating - adverse effects</topic><topic>Brain Neoplasms - epidemiology</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - therapy</topic><topic>Cell Transformation, Neoplastic - pathology</topic><topic>Chi-Square Distribution</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>EARTH PLANET</topic><topic>Female</topic><topic>Glioma - epidemiology</topic><topic>Glioma - mortality</topic><topic>Glioma - pathology</topic><topic>Glioma - therapy</topic><topic>GLIOMAS</topic><topic>Glycosides</topic><topic>HAZARDS</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Lignans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>PATIENTS</topic><topic>Progression-Free Survival</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Statistics, Nonparametric</topic><topic>Temozolomide - adverse effects</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murphy, Erin S.</creatorcontrib><creatorcontrib>Leyrer, Charles M.</creatorcontrib><creatorcontrib>Parsons, Michael</creatorcontrib><creatorcontrib>Suh, John H.</creatorcontrib><creatorcontrib>Chao, Samuel T.</creatorcontrib><creatorcontrib>Yu, Jennifer S.</creatorcontrib><creatorcontrib>Kotecha, Rupesh</creatorcontrib><creatorcontrib>Jia, Xuefei</creatorcontrib><creatorcontrib>Peereboom, David M.</creatorcontrib><creatorcontrib>Prayson, Richard A.</creatorcontrib><creatorcontrib>Stevens, Glen H.J.</creatorcontrib><creatorcontrib>Barnett, Gene H.</creatorcontrib><creatorcontrib>Vogelbaum, Michael A.</creatorcontrib><creatorcontrib>Ahluwalia, Manmeet S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murphy, Erin S.</au><au>Leyrer, Charles M.</au><au>Parsons, Michael</au><au>Suh, John H.</au><au>Chao, Samuel T.</au><au>Yu, Jennifer S.</au><au>Kotecha, Rupesh</au><au>Jia, Xuefei</au><au>Peereboom, David M.</au><au>Prayson, Richard A.</au><au>Stevens, Glen H.J.</au><au>Barnett, Gene H.</au><au>Vogelbaum, Michael A.</au><au>Ahluwalia, Manmeet S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Malignant Transformation of Low-Grade Glioma</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2018-03-15</date><risdate>2018</risdate><volume>100</volume><issue>4</issue><spage>965</spage><epage>971</epage><pages>965-971</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>The incidence, risk factors, and outcomes of low-grade glioma patients who undergo malignant transformation (MT) in the era of temozolomide are not well known. This study evaluates these factors in a large group of World Health Organization grade 2 glioma patients treated at a tertiary-care institution.
Patient, tumor, and treatment factors were analyzed using an institutional review board–approved low-grade glioma database. Characteristics were compared using χ2 and Wilcoxon signed rank tests. Time to event was summarized using proportional hazards models. Univariate and multivariate survival analyses were performed.
Of a total of 599 patients, 124 underwent MT; 76 (61.3%) had biopsy-proven MT. The MT incidence was 21%, and the median time to MT was 56.4 months. The 5- and 10-year progression-free survival rates were 30.6% ± 4.2% and 4.8% ± 1.9%, respectively, for MT patients and 60% ± 2.4% and 38% ± 2.7%, respectively, for non-MT patients. The 5- and 10-year overall survival rates were 75% ± 4.0% and 46% ± 5.0%, respectively, for MT patients and 87% ± 1.7% and 78% ± 2.3%, respectively, for non-MT patients. On multivariate analysis, older age (P = .001), male sex (P = .004), multiple tumor locations (P = .004), chemotherapy alone (P = .012), and extent of resection (P = .045) remained significant predictors of MT.
MT affects survival. Risk factors include older age, male sex, multiple tumor locations, use of chemotherapy alone, and presence of residual disease. Our finding that initial interventions could affect the rate of MT is provocative, but these data should be validated using data from prospective trials. In addition to improving survival, future therapeutic efforts should focus on preventing MT.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29485076</pmid><doi>10.1016/j.ijrobp.2017.12.258</doi><tpages>7</tpages></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2018-03, Vol.100 (4), p.965-971 |
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| subjects | Adolescent Adult Age Factors Aged Aged, 80 and over Analysis of Variance Antineoplastic Agents - adverse effects Antineoplastic Agents - therapeutic use Antineoplastic Agents, Alkylating - adverse effects Brain Neoplasms - epidemiology Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - therapy Cell Transformation, Neoplastic - pathology Chi-Square Distribution Child Child, Preschool EARTH PLANET Female Glioma - epidemiology Glioma - mortality Glioma - pathology Glioma - therapy GLIOMAS Glycosides HAZARDS Humans Incidence Infant Lignans Male Middle Aged PATIENTS Progression-Free Survival RADIOLOGY AND NUCLEAR MEDICINE Risk Factors Sex Factors Statistics, Nonparametric Temozolomide - adverse effects Time Factors Young Adult |
| title | Risk Factors for Malignant Transformation of Low-Grade Glioma |
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