Summary and Further Reading

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

Summary

  • Oligodendrogliomas, defined by the IDHmt, 1p/19q codeletion, are gliomas associated with the best prognosis (median survival ≈10 to 15 years)
  • Maximal safe surgical resection is recommended, when possible
  • After surgery (whether complete or not), low-grade oligodendrogliomas can be managed with a careful wait and see policy
  • In low-grade oligodendrogliomas needing treatment other than surgery, RT plus PCV is the standard of care
  • In anaplastic oligodendrogliomas, initial treatment with RT plus PCV is the standard of care
  • In both low-grade and anaplastic oligodendrogliomas, RT plus PCV improves OS compared with RT alone
  • Whether oligodendrogliomas can be treated with first-line ChT alone in order to defer RT and its potential neurotoxicity remains to be determined
  • At recurrence/progression, there is no standard of care
  • Patients previously treated with RT plus PCV can benefit from second-line TMZ or bevacizumab
  • Strategies directed against the IDH mutation might help in treating recurrent oligodendrogliomas in the future

Further Reading

Buckner JC, Shaw EG, Pugh SL, et al. Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 2016; 374:1344–1355.

Cairncross G, Wang M, Shaw E, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 2013; 31:337–343.

Cairncross JG, Ueki K, Zlatescu MC, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 1998; 90:1473–1479.

Cairncross JG, Wang M, Jenkins RB, et al. Benefit from procarbazine, lomustine, and vincristine in oligodendroglial tumors is associated with mutation of IDH. J Clin Oncol 2014; 32:783–790.

Kouwenhoven MC, Kros JM, French PJ, et al. 1p/19q loss within oligodendroglioma is predictive for response to first line temozolomide but not to salvage treatment. Eur J Cancer 2006; 42:2499–2503.

Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016; 131:803–820.

van den Bent MJ. Anaplastic oligodendroglioma and oligoastrocytoma. Neurol Clin 2007; 25:1089–1109, ix–x.

van den Bent MJ. Chemotherapy for low-grade glioma: when, for whom, which regimen? Curr Opin Neurol 2015; 28:633–938.

van den Bent MJ, Brandes AA, Taphoorn MJ, et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC Brain Tumor Group Study 26951. J Clin Oncol 2013; 31:344–350.

van den Bent MJ, Chinot O, Boogerd W, et al. Second-line chemotherapy with temozolomide in recurrent oligodendroglioma after PCV (procarbazine, lomustine and vincristine) chemotherapy: EORTC Brain Tumor Group phase II study 26972. Ann Oncol 2003; 14:599–602.

van den Bent MJ, Taphoorn MJ, Brandes AA, et al. Phase II study of first-line chemotherapy with temozolomide in recurrent oligodendroglial tumors: the European Organization for Research and Treatment of Cancer Brain Tumor Group Study 26971. J Clin Oncol 2003; 21:2525–2528.

Wesseling P, van den Bent M, Perry A. Oligodendroglioma: pathology, molecular mechanisms and markers. Acta Neuropathol 2015; 129:809–827.

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Last update: 18 September 2017