Radiotherapy in Oligodendroglioma

Chapter 6 - The Essentials in Radiation Oncology for Brain Tumours

Radiotherapy in Oligodendroglioma

Grade 3 1p/19q codeleted oligodendrogliomas (anaplastic oligodendrogliomas) are traditionally treated with primary RT and adjuvant nitrosourea-containing ChT (usually the PCV [procarbazine, lomustine and vincristine] regimen). Conformal RT is given to a dose of 59.4 Gy in 33 fractions (1.8 Gy per fraction). The combination achieves the best long-term survival and disease control.

Radiotherapy in Skull Base Tumours

Progressive chordomas and chondrosarcomas invading surrounding structures and poorly accessible by radical surgery are treated with fractionated conformal RT or, if small, with stereotactic high-precision techniques.

Although proton therapy is frequently employed, there is no evidence that it offers superior results either in terms of efficacy or toxicity. The most important Prognostic factor is the extent of surgery.

Radiotherapy for Brain Metastases

RT is the mainstay of treatment in brain metastases. Patients with symptomatic multiple brain metastases from a variety of tumours can be treated with WBRT, generally given as 20 Gy in 5 fractions.

Patients with solitary lesions which are not excisable are effectively treated with single-fraction radiosurgery. WBRT is no longer recommended as an additional treatment following surgery or radiosurgery. It is also not used in patients with adverse prognostic factors and short life expectancy, as it is not associated with a survival gain or quality of life gain compared with supportive care alone. The addition of concomitant ChT is not associated with a survival gain.

Revision Questions

  1. What is the common genetic abnormality in oligodendrogliomas?
  2. What are the challenges of treatment for chordoma and chondrosarcoma?
  3. What are the RT treatment options for brain metastases?

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Last update: 18 September 2017