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Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Management of Specific Tumor Types and Locations

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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).[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.

Mature results from the European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumor Group Study 26951 (NCT00002840), a phase III, randomized study with 11.7 years of follow up demonstrated increased OS and progression-free survival in patients with anaplastic oligodendroglial tumors with six cycles of adjuvant PCV chemotherapy after radiation therapy compared with radiation therapy alone.[5] The OS was significantly longer in the radiation therapy and PCV arm (42.3 months vs. 30.6 months; hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.60–0.95). 1p/19q-codeleted tumors derived more benefit from adjuvant PCV chemotherapy compared with non-1p/19q-deleted tumors.[5][Level of evidence: 1iiA]

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