TY - JOUR
T1 - Variations in the management of diffuse low-grade gliomas-A Scandinavian multicenter study
AU - Munkvold, Bodil Karoline Ravn
AU - Solheim, Ole
AU - Bartek, Jiri
AU - Corell, Alba
AU - de Dios, Eddie
AU - Gulati, Sasha
AU - Helseth, Eirik
AU - Holmgren, Klas
AU - Jensdottir, Margret
AU - Lundborg, Mina
AU - Mireles, Eduardo Erasmo Mendoza
AU - Mahesparan, Ruby
AU - Tveiten, Øystein Vesterli
AU - Milos, Peter
AU - Redebrandt, Henrietta Nittby
AU - Pedersen, Lars Kjelsberg
AU - Ramm-Pettersen, Jon
AU - Sjöberg, Rickard L
AU - Sjögren, Björn
AU - Sjåvik, Kristin
AU - Smits, Anja
AU - Tomasevic, Gregor
AU - Vecchio, Tomás Gómez
AU - Vik-Mo, Einar O
AU - Zetterling, Maria
AU - Salvesen, Øyvind
AU - Jakola, Asgeir S
N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85121127191&partnerID=8YFLogxK
U2 - 10.1093/nop/npab054
DO - 10.1093/nop/npab054
M3 - Journal article
C2 - 34777840
SN - 2054-2577
VL - 8
SP - 706
EP - 717
JO - Neuro-Oncology Practice
JF - Neuro-Oncology Practice
IS - 6
ER -