Phase II Trial of Procarbazine, Lomustine, and Vincristine as Initial Therapy for Patients With Low-Grade Oligodendroglioma or Oligoastrocytoma: Efficacy and Associations With Chromosomal Abnormalities

Abstract

PCV produces tumor regressions in a meaningful proportion of patients with LGO/LGOA. Toxicity, especially myelosuppression, is significant. Loss of 1p and 19q seems limited to patients with pure LGO and is inversely related to p53 alterations.

Recent developments in the use of chemotherapy in brain tumours

“…[55][56][57][58] These trials show that objective responses are rare, despite prolonged disease stabilization in the majority of patients. Measuring response in low-grade tumours in the absence of contrast enhancement may be particularly difficult.…”

Response to postoperative radiotherapy as a prognostic factor for patients with low-grade gliomas

“…Several phase II studies of PCV or TMZ chemotherapy regimens in the treatment of new, progressive or recurrent LGGs have been performed (20)(21)(22)(23)(24)(25)(26). A similar response rate was observed for astrocytomas and oligodendrogliomas (20,25,26).…”

Preoperative Chemotherapy for Infiltrative Low-Grade Oligoastrocytoma: a Useful Strategy to Maximize Surgical Resection -Case Report-

“…8) So far, only loss of heterozygosity of 1p/19q has been demonstrated to statistically correlate with the response to chemotherapy and survival. 3,10,14,20,24,25,28) If neoadjuvant chemotherapy reduces tumor volume and infiltration, surgery allows further cytoreduction, as demonstrated in solid neoplasms of other tissues such as the lung, testicle, and breast. 7,9,16) The combination of neoadjuvant chemotherapy and surgery to treat cerebral LGG has been reported only in a patient with a low-grade oligodendroglioma that progressed after prior partial surgical resection.…”

“…For a long time, radiotherapy has represented the mainstay of treatment for this type of lesions, but radiation-induced toxicity still has to be carefully considered during decision-making. 12) Although no consensus on the routine use of chemotherapy in treating LGG, and especially astrocytomas, has been reached yet, its efficacy has been demonstrated in terms of clinical and radiological response either as initial treatment [2][3][4]8,10,13,15,24,27) or as salvage therapy after surgery and radiotherapy. 17,18,22,23,26,27) Complete neuroradiological disappearance of a tumor is infrequent, so good response is defined as volumetric regression or stabilization over time.…”

“…In this group of patients, once biopsy has been performed, radiotherapy or chemotherapy is then administered. Chemotherapy can reduce volume and infiltration of LGGs, [2][3][4]8,10,13,17,18,22,24,26,27) and can permit total resection of an initially diffuse tumor. 6) We report a case of a patient in which neoadjuvant chemotherapy allowed surgical treatment of a large infiltrating LGG.…”