Variations in the management of diffuse low-grade gliomas-A Scandinavian multicenter study.

Autor:	Munkvold BKR; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway., Solheim O; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Bartek J Jr; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark., Corell A; Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden., de Dios E; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Neuroscience, Uppsala University, Uppsala, Sweden., Gulati S; Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway., Helseth E; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway., Holmgren K; Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden.; Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden., Jensdottir M; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden., Lundborg M; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway., Mireles EEM; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway., Mahesparan R; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway., Tveiten ØV; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway., Milos P; Department of Neurosurgery, Linköping University Hospital, Sweden., Redebrandt HN; Department of Clinical Sciences, Lund University, Lund, Sweden.; Department of Neurosurgery, Skåne University Hospital, Lund, Sweden., Pedersen LK; Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway., Ramm-Pettersen J; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway., Sjöberg RL; Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden.; Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden., Sjögren B; Department of Neurosurgery, Linköping University Hospital, Sweden., Sjåvik K; Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway., Smits A; Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden., Tomasevic G; Department of Neurosurgery, Skåne University Hospital, Lund, Sweden., Vecchio TG; Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden., Vik-Mo EO; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway., Zetterling M; Department of Neuroscience, Uppsala University, Uppsala, Sweden.; Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden., Salvesen Ø; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway., Jakola AS; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.; Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Jazyk:	angličtina
Zdroj:	Neuro-oncology practice [Neurooncol Pract] 2021 Sep 04; Vol. 8 (6), pp. 706-717. Date of Electronic Publication: 2021 Sep 04 (Print Publication: 2021).
DOI:	10.1093/nop/npab054
Abstrakt:	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. (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)
Databáze:	MEDLINE
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