Successful treatment of low‐grade oligodendroglial tumors with a chemotherapy regimen of procarbazine, lomustine, and vincristine

Abstract

BACKGROUND Anaplastic oligodendroglioma (OD) tumors, especially those with the combined loss of the short arm of chromosome 1 (1p) and the long arm of chromosome 19 (19q), are sensitive to chemotherapy. Only limited data are available on the role of chemotherapy in low‐grade OD. The authors retrospectively studied the outcome of the procarbazine, lomustine, and vincristine (PCV) chemotherapy regimen in a group of 16 patients with newly diagnosed OD and 5 patients with recurrent low‐grade OD. METHODS Two groups of patients were studied: newly diagnosed patients with large OD and mixed oligoastrocytomas (OA) and patients with recurrent OD and OA after radiotherapy who still showed nonenhancing tumors. Treatment consisted of standard PCV chemotherapy. In the newly diagnosed and responding patients, radiotherapy was withheld until the time of disease recurrence. Responses were assessed by T2‐weighted magnetic resonance image (MRI) scans. Loss of chromosome 1p and 19q was assessed using fluorescent in situ hybridization with locus‐specific probes. RESULTS Three of five patients with recurrent tumors responded. Thirteen of the 16 newly diagnosed patients showed evidence of response. The median time to disease progression in this group was > 24 months. Only one of these patients experienced disease progression while receiving chemotherapy. Several patients showed a signficant clinical improvement despite only a modest improvement of the tumor on the MRI scans. Even patients without loss of 1p or 19q showed satisfactory responses. No TP53 mutations were found. CONCLUSIONS Newly diagnosed patients with OD tumors, with or without loss of 1p/19q, responded to PCV chemotherapy. Up‐front chemotherapy may be indicated especially for patients with large tumors. MRI scans were of limited value for the assessment of response. A Phase III trial should be initiated to compare radiotherapy with chemotherapy. Cancer 2005. © 2005 American Cancer Society.

Genetic and metabolic predictors of chemosensitivity in oligodendroglial neoplasms

“…Response categories were: -CR-complete response (disappearance of all tumour, off steroids and neurologically stable or improved); PR -partial response (50% or greater reduction in cross-sectional area, steroids stable or reduced, and neurologically stable or improved); PD -progressive disease (25% or greater increase in cross sectional area or any new tumour on CT/MR images and/or neurologically worse with steroids stable or increased); SD -stable disease (all other situations). In 10 nonenhancing cases and three for whom contrast enhancement was not assessable, response was assessed using T2-weighted images (Hoang-Xuan et al, 2004;Stege et al, 2005). An additional minor response (MR) category (425 -o50% reduction in cross-sectional area, steroids stable or reduced, and neurologically stable or improved) was included, as some cases showed radiological reduction in cross sectional T2W area of 425 -o50%, accompanied by clinical benefit.…”

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

“…Chemotherapy was effective in previously treated and untreated patients (21,22,26). Although oligodendrogliomas with deletion of chromosome 1p and 19q may be more sensitive to treatment (23,28), tumors without these deletions were also responsive to chemotherapy (27). The natural history of oligodendroglial tumors is more protracted compared with astrocytic tumors.…”

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

“…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.…”

“…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.…”

“…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.…”