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Sasaki H, Yoshida K. Treatment Recommendations for Adult Patients with Diffuse Gliomas of Grades II and III According to the New WHO Classification in 2016. Neurol Med Chir (Tokyo) 2017; 57:658-666. [PMID: 28845038 PMCID: PMC5735229 DOI: 10.2176/nmc.ra.2017-0071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
With advanced understanding of molecular background and correlation with therapeutic outcomes, the revised 4th edition of World Health Organization (WHO) classification of central nervous system (CNS) tumors incorporated molecular information into the definition of diffuse gliomas. Indeed, oligodendroglioma and astrocytoma are now defined by molecular signature, with diagnosis of glioblastoma being made by histology. In parallel, numerous clinical trials are underway all over the world, and important findings are being produced every year that have an impact on patient outcomes. Moreover, novel therapies/technologies are also being actively developed; however, there are still many CNS tumors for which no effective therapy has been established except radiotherapy. In this article, the authors review the recent results of major clinical trials and present their treatment recommendations for patients with adult, supratentorial diffuse gliomas of grades II and III stratified according to the new WHO classification.
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Affiliation(s)
- Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine
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Peyrl A, Frischer J, Hainfellner JA, Preusser M, Dieckmann K, Marosi C. Brain tumors - other treatment modalities. HANDBOOK OF CLINICAL NEUROLOGY 2017; 145:547-560. [PMID: 28987193 DOI: 10.1016/b978-0-12-802395-2.00034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Management of tumors of the central nervous system is challenging for clinicians for various reasons, including complex diagnostic procedures, limited penetration of drugs into brain tissue, and the prerequisite to preserve brain function in any case of therapeutic intervention. Therapeutic success is dependent on the efforts, skills, and cooperation of involved specialists and disciplines. Knowledge and ability to apply adequate therapeutic modalities in an interdisciplinary approach in due time are crucial, necessitating coordination of diagnostic procedures and therapeutic interventions by means of multidisciplinary brain tumor boards. In this chapter we present in brief the essential current standards and future perspectives for therapy modalities that complement surgery of brain tumors.
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Affiliation(s)
- Andreas Peyrl
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Josa Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Institute of Neurology, Medical University of Vienna, Vienna, Austria.
| | - Matthias Preusser
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Vogelbaum MA, Hu C, Peereboom DM, Macdonald DR, Giannini C, Suh JH, Jenkins RB, Laack NN, Brachman DG, Shrieve DC, Souhami L, Mehta MP. Phase II trial of pre-irradiation and concurrent temozolomide in patients with newly diagnosed anaplastic oligodendrogliomas and mixed anaplastic oligoastrocytomas: long term results of RTOG BR0131. J Neurooncol 2015; 124:413-20. [PMID: 26088460 PMCID: PMC4584176 DOI: 10.1007/s11060-015-1845-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022]
Abstract
We report on the long-term results of a phase II study of pre-irradiation temozolomide followed by concurrent temozolomide and radiotherapy (RT) in patients with newly diagnosed anaplastic oligodendroglioma (AO) and mixed anaplastic oligoastrocytoma. Pre-RT temozolomide was given for up to 6 cycles. RT with concurrent temozolomide was administered to patients with less than a complete radiographic response. Forty eligible patients were entered and 32 completed protocol treatment. With a median follow-up time of 8.7 years (range 1.1-10.1), median progression-free survival (PFS) is 5.8 years (95 % CI 2.0, NR) and median overall survival (OS) has not been reached (5.9, NR). 1p/19q data are available in 37 cases; 23 tumors had codeletion while 14 tumors had no loss or loss of only 1p or 19q (non-codeleted). In codeleted patients, 9 patients have progressed and 4 have died; neither median PFS nor OS have been reached and two patients who received only pre-RT temozolomide and no RT have remained progression-free for over 7 years. 3-year PFS and 6-year OS are 78 % (95 % CI 61-95 %) and 83 % (95 % CI 67-98 %), respectively. Codeleted patients show a trend towards improved 6-year survival when compared to the codeleted procarbazine/CCNU/vincristrine (PCV) and RT cohort in RTOG 9402 (67 %, 95 % CI 55-79 %). For non-codeleted patients, median PFS and OS are 1.3 and 5.8 years, respectively. These updated results suggest that the regimen of dose intense, pre-RT temozolomide followed by concurrent RT/temozolomide has significant activity, particularly in patients with 1p/19q codeleted AOs and MAOs.
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Affiliation(s)
- Michael A Vogelbaum
- Cleveland Clinic Foundation, 9500 Euclid Avenue, ND40, Cleveland, OH, 44195, USA.
| | - Chen Hu
- RTOG Statistical Center, 1818 Market Street, Suite 1600, Philadelphia, PA, 19103, USA
| | - David M Peereboom
- Cleveland Clinic Foundation, 9500 Euclid Avenue, ND40, Cleveland, OH, 44195, USA
| | - David R Macdonald
- University of Western Ontario London Regional Cancer Centre, 790 Commissioners Road East, London, ON, N6A 4L6, Canada
| | | | - John H Suh
- Cleveland Clinic Foundation, 9500 Euclid Avenue, ND40, Cleveland, OH, 44195, USA
| | | | - Nadia N Laack
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David G Brachman
- Arizona Oncology Services Foundation, PO Box 41700, Phoenix, AZ, 85080, USA
| | - Dennis C Shrieve
- University of Utah Health Science Center, 1950 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Luis Souhami
- McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Minesh P Mehta
- University of Maryland, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA
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