Treatment: Multimodality Treatment

Chapter 5 - Treatment Strategies for Anaplastic Astrocytoma and Glioblastoma

The next question is whether combined treatment modalities might be superior to single treatment for LGGs.

This question was addressed in the RTOG 9802 trial. High-risk patients (age >40 years or incomplete resection) were randomised to either RT or RT plus adjuvant ChT
with PCV (6 cycles).

Adjuvant PCV after RT prolonged PFS and OS compared with RT alone: median survival was increased by 5.5 years, and the 5-year and 10-year survival rates increased by 9% and 20%, respectively. Molecular subgroup analyses in this trial are, however, incomplete.

Combined treatment with RT and PCV therefore has a significantly greater effect than single-modality treatment with RT alone.

It must however be noted that this study provides incomplete information on the molecular status of the patients, as 1p/19q codeletion status was not evaluated.

It remains highly debated whether PCV can be replaced by TMZ, which is much better tolerated and associated with fewer side effects.

Revision Questions

  1. Is combined therapy superior to single-modality treatment for LGG?
  2. How would you treat a low-risk LGG patient with a small resectable tumour?
  3. How would you treat a high-risk LGG patient with an unresectable tumour?

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Last update: 18 September 2017