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Management of Specific Tumor Types and Locations

    continued...

    Postoperative radiation alone has been compared to 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. One hundred thirty-nine patients were randomly assigned to radiation therapy, and 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 OS.[2][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.

    Glioblastomas

    Standard treatment options:

    1. Surgery plus radiation therapy.
    2. Surgery plus radiation therapy and chemotherapy.
    3. Carmustine-impregnated polymer implanted during initial surgery.
    4. Radiation therapy and concurrent chemotherapy.

    For patients with glioblastoma (WHO grade IV), the cure rate is very low with standard local treatment. These patients 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.

    Oligodendroglial Tumors

    Oligodendrogliomas

    Standard treatment options:

    • Surgery plus radiation therapy; however, some controversy exists concerning the timing of radiation therapy. A study (EORTC-22845) of 300 patients who had surgery and were randomly assigned to either radiation therapy or watch and wait did not show a difference in OS in the two groups.[3][Level of evidence: 1iiA]

    Oligodendrogliomas (WHO grade II) behave like diffuse astrocytomas.

    Anaplastic oligodendrogliomas

    Standard treatment options:

    1. Surgery plus radiation therapy.
    2. Surgery plus radiation therapy plus chemotherapy.[4]
    3. Patients with an allelic loss at 1p and 19q have a higher than average response rate to PCV chemotherapy.[5][Level of evidence: 3iiiDiv]
    4. A recent phase III study compared radiation therapy alone with chemotherapy plus radiation therapy. Progression-free survival was increased but OS was not.[6][Level of evidence: 1iiDiii] This was true in the 1p and 19q allelic deletion group as well. These studies are ongoing.
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