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Successful
treatment of low-grade oligodendroglial tumors with a chemotherapy regimen of
procarbazine, lomustine, and vincristine
Stege EM, Kros JM, de Bruin HG, Enting RH, van Heuvel I, Looijenga LH, van
der Rijt CD, Smitt PA, van den Bent MJ
Department of Neurology/Neuro-Oncology, Erasmus University Medical Center/Daniel
Den Hoed Cancer Center, Rotterdam, The Netherlands.
Background. Anaplastic oligodendroglioma (OD) tumors, especially those with the
combined loss of the short arm of chromosome 1 (1p) and the long arm of
chromosome 19 (19q), are sensitive to chemotherapy.
Only limited data are
available on the role of chemotherapy in low-grade OD.
The authors
retrospectively studied the outcome of the procarbazine, lomustine, and
vincristine (PCV) chemotherapy regimen in a group of 16 patients with newly
diagnosed OD and 5 patients with recurrent low-grade OD.
Methods. Two groups of
patients were studied: newly diagnosed patients with large OD and mixed
oligoastrocytomas (OA) and patients with recurrent OD and OA after radiotherapy
who still showed nonenhancing tumors.
Treatment consisted of standard PCV
chemotherapy.
In the newly diagnosed and responding patients, radiotherapy was
withheld until the time of disease recurrence.
Responses were assessed by
T2-weighted magnetic resonance image (MRI) scans.
Loss of chromosome 1p and 19q
was assessed using fluorescent in situ hybridization with locus-specific probes.
Results. Three of five patients with recurrent tumors responded.
Thirteen of the
16 newly diagnosed patients showed evidence of response.
The median time to
disease progression in this group was >24 months.
Only one of these patients
experienced disease progression while receiving chemotherapy.
Several patients
showed a signficant clinical improvement despite only a modest improvement of
the tumor on the MRI scans.
Even patients without loss of 1p or 19q showed
satisfactory responses.
No TP53 mutations were found.
Conclusions. Newly
diagnosed patients with OD tumors, with or without loss of 1p/19q, responded to
PCV chemotherapy.
Up-front chemotherapy may be indicated especially for patients
with large tumors.
MRI scans were of limited value for the assessment of
response.
A Phase III trial should be initiated to compare radiotherapy with
chemotherapy.
Copyright (c) 2005 American Cancer Society.
PMID: 15637687 [PubMed - indexed for MEDLINE]
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