Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Management of Specific Tumor Types and Locations
Postoperative radiation alone has been compared with postoperative chemotherapy alone in patients with anaplastic gliomas (i.e., 144 astrocytomas, 91 oligoastrocytomas, and 39 oligodendrogliomas) with crossover to the other modality at the time of tumor progression. Of the 139 patients randomly assigned to radiation therapy, 135 were randomly assigned to chemotherapy with a 32-week course of either procarbazine + lomustine + vincristine (PCV) or single-agent temozolomide (2:1:1 randomization). The order of the modalities did not affect time to treatment failure (TTF) or overall survival (OS).[Levels of evidence: 1iiA and 1iiD] Neither TTF nor OS differed across the treatment arms.
Patients with anaplastic astrocytomas are appropriate candidates for clinical trials designed to improve local control by adding newer forms of treatment to standard treatment. Information about ongoing clinical trials is available from the NCI Web site.
Standard treatment options for patients with newly diagnosed disease:
- Surgery plus radiation therapy.
- Surgery plus radiation therapy and chemotherapy.
Carmustine-impregnated polymer implanted during initial surgery.
- Radiation therapy and concurrent chemotherapy.
The standard-of-care treatment for patients with newly diagnosed glioblastoma is surgery followed by concurrent radiation therapy and daily temozolomide, and then followed by six cycles of temozolomide. This standard therapy is based on a large, multicenter, randomized trial (NCT00006353) conducted by the European Organization for Research and Treatment of Cancer (EORTC) and National Cancer Institute of Canada (NCIC), which reported a survival benefit with concurrent radiation therapy and temozolomide compared with radiation therapy alone.[3,4][Level of evidence: 1iiA] In that study, 573 patients with glioblastoma were randomly assigned to receive standard radiation to the tumor volume with a 2- to 3-cm margin (60 Gy, 2 Gy per fraction, over 6 weeks) alone or with temozolomide (75 mg/m2 orally per day during radiation therapy for up to 49 days, followed by a 4-week break and then up to six cycles of five daily doses every 28 days at a dose of 150 mg/m2, increasing to 200 mg/m2 after the first cycle). Patients in the combined therapy group were given prophylactic therapy for pneumocystis carinii during the period of concomitant radiation therapy and temozolomide. OS was statistically significantly better in the combined radiation therapy-temozolomide group (hazard ratio [HR]death, 0.6; 95% confidence interval [CI], 0.5-0.7; OS at 3 years was 16.0% vs. 4.4%).