P17.77 PRELIMINARY DATA ON THE PATTERN OF CARE IN GRADE III GLIOMA PATIENTS IN 6 LOMBARDIA HOSPITALS, 2012-2013

The standard of care in grade III gliomas is still controversial; concerning anaplastic astrocytoma, the addition of chemotherapy to post-surgery radiation therapy is being assessed in the CATNON EORTC trial, whereas long-term follow-up data on grade III gliomas with oligodendroglial component suggest a strong impact of chemotherapy on survival, especially in patients positive for 1p/19q LOH. We have collected data on the pattern of care in grade III glioma patients prospectively treated in 6 Hospitals in Lombardia over the last 2 years. 78 patients were diagnosed (42 M, 36 F), with a median age of 50 (range 17-79). Histological diagnosis was AA in 49, AOD in 10, AOA in 19. The disease onset was characterized by seizures in 35 patients, intracranial hypertension in 7 and by focal non-epileptic neurological signs in 27. Surgery was total/subtotal resection in 43, partial resection in 18, biopsy in 17. Molecular biology data were available in 23/49 of the AA group (10 with methylated MGMT, 8 unmethylated MGMT, 1 with LOH 1p/10q) and in 16/29 of AOD/AOA group (12 with LOH for 1p/19q). Data about post-surgical treatment were available in 71 ot the 78 patients (42 AA and 29 AOD/AOA). Concerning AA, 3 patients died within 3 months from surgery (1 for encephalitis, 1 for early progression, 1 for perioperative complications). In the reamining 39, 37 were treated with both RT and CT (of whom 27 with the Stupp schedule and 10 with adjuvant temozolomide), 2 were treated with RT only. Toxicities included one fatal herpetic encephalitis, one Herpes Zoster, 4 grade 3-4 platelet toxicity, one case of pancytopenia. In AOD and AOA patients, 27 out of 29 were treated with radiotherapy and only 2 with upfront chemotherapy aiming to differe RT. 4 of the 27 received only radiotherapy, while 23 were treated by both RT and CT (of whom 5 with the Stupp schedule and 18 with adjuvant CT). 2 patients had to interrupt CT due to piastrinopenia. Overall, the results stress the need to implement molecular biology analyses and confirm the heterogeneity in the clinical approach to newly diagnosed grade III gliomas. In AA, both the Stupp schedule and adjuvant CT after RT are used, whereas in gliomas with oligodendroglial component a low number of patients start being treated with upfront chemoterapy if they present favourable prognostic factors.