Background: Grade-2 gliomas (G2-glioma) are uncommon. In 2016, RTOG9802 established the addition of chemotherapy after radiation (CRT) as a new standard of care for patients with high-risk G2-glioma, defined as subtotal resection or age ≥40 yrs. Here, we report current practices using real-world data.Methods: Patients diagnosed with G2-glioma from 1 January 2016 to 31 December 2022 were identified in BRAIN, a prospective clinical registry collecting data on patients with brain tumours. High- and low-risk were defined as per RTOG9802. Two time periods, January 2016–December 2019 (TP1) and January 2020–December 2022 (TP2), were defined. Survival was estimated using the Kaplan–Meier method.Results: 224 patients were identified. Overall, 38 (17%) were low-risk, with 35 (91%) observed without further treatment. A total of 186 (83%) were high-risk, with 96 (52%) observed, 63 (34%) receiving CRT, and 19 (10%) receiving radiation. Over time, CRT use increased (TP1 vs. TP2: 22% vs. 36%,p= 0.004), and the rate of biopsy (TP1 vs. TP2: 35% vs. 20%,p= 0.02) and radiotherapy alone (TP1 vs. TP2: 14% vs. 4%,p= 0.01) decreased. Median progression-free survival (PFS) was significantly longer in high-risk patients who received CRT (NR) over observation (39 months) (HR 0.49,p= 0.007). In high-risk patients who were observed, 59 (61%) were progression-free at 12 months and 10 (10%) at 5 years. OS data remains immature.Conclusions: Congruent with RTOG9802, real-world BRAIN data shows CRT is associated with improved PFS compared to observation in high-risk G2-glioma. Whilst CRT use has increased over time, observation after surgery remains the most common strategy, with some high-risk patients achieving clinically meaningful PFS. Validated biomarkers are urgently required to better inform patient management.
背景：2级胶质瘤（G2-glioma）较为罕见。2016年，RTOG9802研究确立了放疗后联合化疗（CRT）作为高危G2-glioma患者（定义为次全切除或年龄≥40岁）的新标准治疗方案。本研究基于真实世界数据报告当前临床实践现状。 方法：通过前瞻性脑肿瘤临床登记数据库BRAIN，识别2016年1月1日至2022年12月31日期间确诊的G2-glioma患者。高危与低危分组标准参照RTOG9802方案。将研究时段划分为2016年1月-2019年12月（TP1）和2020年1月-2022年12月（TP2）两个时期。采用Kaplan-Meier法评估生存结局。 结果：共纳入224例患者。总体而言，38例（17%）为低危患者，其中35例（91%）仅接受观察随访。186例（83%）为高危患者，其中96例（52%）接受观察随访，63例（34%）接受CRT治疗，19例（10%）仅接受放疗。随时间推移，CRT使用率显著提升（TP1 vs. TP2：22% vs. 36%，p=0.004），而单纯活检（TP1 vs. TP2：35% vs. 20%，p=0.02）与单纯放疗（TP1 vs. TP2：14% vs. 4%，p=0.01）比例下降。高危患者中，接受CRT治疗组的中位无进展生存期（NR）较观察组（39个月）显著延长（HR 0.49，p=0.007）。观察组高危患者中，59例（61%）在12个月时保持无进展，10例（10%）在5年时保持无进展。总生存期数据尚未成熟。 结论：与RTOG9802研究结果一致，真实世界BRAIN数据显示对于高危G2-glioma患者，CRT治疗相较于观察随访可显著改善无进展生存期。尽管CRT使用率随时间推移逐步上升，术后观察随访仍是最常见的临床策略，且部分高危患者可获得具有临床意义的无进展生存期。亟需经过验证的生物标志物以优化患者管理决策。
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