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Management of Specific Tumor Types and Locations


    Anaplastic oligodendrogliomas (WHO grade III) have a low cure rate with standard local treatment, but their prognosis is generally better than that of anaplastic astrocytomas. Since anaplastic oligodendrogliomas are uncommon, phase III randomized trials restricted to them are not practical. They are generally managed with the following:

    • Postoperative radiation therapy (PORT) alone, with chemotherapy at progression.
    • Postoperative chemotherapy with radiation at progression.
    • PORT plus chemotherapy, even though the combination of radiation plus chemotherapy is not known to be superior in outcome to sequential modality therapy.

    PORT 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 PCV or single-agent temozolomide (2:1:1 randomization). The order of the modalities did not affect TTF or OS.[2][Levels of evidence: 1iiA and 1iiD]. Neither TTF nor OS differed across the treatment arms.

    These patients are appropriate candidates for clinical trials designed to improve local control by adding newer forms of treatment. Information about ongoing clinical trials is available from the NCI Web site.

    Mixed Gliomas

    Standard treatment options:

    1. Surgery plus radiation therapy.
    2. Surgery plus radiation therapy plus chemotherapy.

    Mixed glial tumors, which include oligoastrocytoma (WHO grade II) and anaplastic oligoastrocytoma (WHO grade III), have a prognosis similar to that for astrocytic tumors of corresponding grades and can be treated as such.

    Ependymal Tumors

    Grade I and II ependymal tumors

    Standard treatment options:

    1. Surgery alone if the tumor is totally resectable.
    2. Surgery followed by radiation therapy to known or suspected residual tumor.

    Ependymomas (WHO grade II) and ependymal tumors (WHO grade I), i.e., subependymoma and myxopapillary ependymomas, are often curable.

    Anaplastic ependymomas

    Standard treatment options:

    • Surgery plus radiation therapy.[7]

    Anaplastic ependymomas (WHO grade III) have variable prognoses that depend on the location and extent of disease. Frequently, but not invariably, anaplastic ependymomas have worse prognoses than lower grade ependymal tumors.


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