Anaplastic (Grade 3) Oligodendroglioma

Chapter 9 - Treatment of Oligodendroglioma (IDHmt, 1p/19q Codeleted)

IDHmt, 1p/19q codeleted anaplastic oligodendrogliomas have a better prognosis compared with anaplastic astrocytomas. Maximal safe resection is indicated, when feasible.

Median survival in IDHmt, 1p/19q codeleted oligodendrogliomas treated with RT followed by chemotherapy (ChT) is approximately 14 years

In anaplastic oligodendroglial tumours, maximum resection is associated with improved survival, especially if imaging shows no residual tumour.

The morphological distinction between low-grade and anaplastic oligodendroglioma is subjective, but in anaplastic tumours further treatment is indicated after surgery.

Outcome in IDHmt, 1p/19q codeleted anaplastic oligodendroglioma is improved if ChT is added to RT (compared to RT alone).

The studies on adjuvant ChT have investigated PCV ChT; similar studies on TMZ in oligodendroglioma have not been performed.

The German NOA-04 trial suggests that RT alone is as effective as ChT alone. This suggests that survival in patients treated with ChT alone will be poorer compared with survival in patients treated with RT plus ChT.

ChT can be given either before or after RT.

RT may have an impact on quality of survival because of effects on cognitive function (memory, attention), interfering with independent living in some patients.

Revision Questions

  1. Following surgery, is adjuvant treatment indicated in anaplastic IDHmt, 1p/19q codeleted tumours?
  2. In anaplastic glioma, is ChT alone more effective than RT alone?
  3. What is the median survival in 1p/19q codeleted anaplastic oligodendroglioma treated with RT and PCV ChT?

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Last update: 18 September 2017