Oligodendroglioma Treatment & Management

  • Author: ABM Salah Uddin, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Feb 3, 2012
 

Medical Care

Individualize treatment of an oligodendroglioma depending on the presence or absence of symptoms, location and biological aggressiveness of the tumor, extent of possible surgical resection, and histopathology and degree of anaplasia. Treatment options vary from conservative treatment of some patients with serial imaging studies and no intervention to aggressive multimodal treatment including surgical resection, radiotherapy, and chemotherapy in others. Because most patients either develop or present with seizures, anticonvulsive therapy is recommended once the patient is diagnosed with oligodendroglioma.

  • Chemotherapy[8]
    • The role of chemotherapy for the treatment of oligodendroglioma was well established by several studies using nitrosourea-based therapy. Most used procarbazine, lomustine (CCNU), and vincristine, a combination chemotherapy regimen (ie, PCV) developed by Levin and coworkers.[9] Patients with pure and mixed oligoastrocytic tumors, newly diagnosed, and recurrent mixed tumors responded to this therapy before receiving radiotherapy. Despite prolonged responses, most patients experience disease relapse and ultimately die of progressive disease. The median time for recurrence was at least 16 months in partial responders and at least 25 months in complete responders. Recurrent tumors are not cured by PCV, and the intensity of treatment may be limited by the bone marrow reserve.[10]
    • Several studies have evaluated the role of temozolomide as second-line chemotherapy for recurrent oligodendroglioma and showed a response rate of about 25% for patients relapsing after PCV therapy. The EORTC study evaluated temozolomide as a first-line chemotherapy for recurrent oligodendroglial tumors and showed a response rate of 54%, with 39% of patients remaining free from progression at 12 months.[11]
    • An interim analysis of a phase II study of intensified chemotherapy (I-PCV) alone for newly diagnosed anaplastic oligodendroglioma showed that median progression-free survival for all patients is 19.5 months, similar to the median progression-free survival for patients receiving radiotherapy alone in the RTOG and EORTC trials. These findings suggest that the patient care is not compromised by initiating treatment with chemotherapy alone and delay of radiotherapy may have a beneficial impact on quality of life.[12]
    • A phase III study preliminary findings reported by Cairncross et al, comparing radiation therapy versus chemotherapy plus radiation in patients with newly diagnosed anaplastic OD and mixed OD, showed overall similar survival in both groups (4.8 y for radiotherapy plus chemotherapy group vs 4.5 y for radiotherapy alone). However, disease progression-free interval was longer for the combined therapy group (2.6 y vs 1.9 y for radiotherapy alone group).[13]
    • New agents are needed for further improvements of survival in OD.
  • Radiation therapy
    • Various studies compared the effects of radiation therapy before and after the maximal surgical resection. The studies showed that the immediate postoperative irradiation in patients with LOG increases the median progression-free survival by 2 years without affecting the overall survival. This result suggests that radiation therapy can be withheld until a clinical or radiologic progression occurs to delay the sequelae of cranial irradiation.
    • The RTOG study compared the effects of pre–radiation therapy dose-intensified PCV chemotherapy followed by radiation therapy versus radiation therapy alone in newly diagnosed oligodendroglioma and anaplastic oligodendroglioma. No difference in overall survival was noted. However, the progression-free survival rate was longer after radiation therapy plus PCV.
Next

Surgical Care

  • Historically, surgery has been the mainstay of treatment for oligodendrogliomas. The extent of resection depends in large part on the location of the tumor and its proximity to "eloquent" brain areas. If possible, the goal is total resection of the tumor. In patients who undergo total gross resection, no further treatment may be necessary, but the patient must be followed up for clinical or radiologic recurrence.
  • The optimal use of radiotherapy in the treatment of oligodendroglioma is not entirely clear. Although differences of opinion exist regarding the efficacy of radiotherapy for oligodendrogliomas, radiation is used routinely at diagnosis in patients who have undergone incomplete removal of nonanaplastic oligodendrogliomas and generally is recommended for patients with anaplastic oligodendrogliomas regardless of the extent of resection. Radiotherapy also is used at recurrence in previously untreated patients. As systemic therapies are becoming available and more effective, delaying radiotherapy in many patients may be prudent to avoid the toxic side effects of radiation to the nervous system.
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

ABM Salah Uddin, MD  Private Practice, Norwood Neurology; Consulting Staff, Department of Neurology, St Vincent's Hospital

ABM Salah Uddin, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Tambi Jarmi, MD  Resident Physician, Department of Internal Medicine, Carraway Methodist Medical Center

Tambi Jarmi, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Amy A Pruitt, MD  Associate Professor of Neurology, University of Pennsylvania School of Medicine; Attending Neurologist, Hospital of the University of Pennsylvania

Amy A Pruitt, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jorge C Kattah, MD  Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and New York Academy of Sciences

Disclosure: Biogen Honoraria Consulting; Bayer Corporation Honoraria Consulting

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Subramanian Hariharan, MD to the development and writing of this article.

References

  1. Elefante A, Peca C, Del Basso De Caro ML, Russo C, Formicola F, Mariniello G, et al. Symptomatic spinal cord metastasis from cerebral oligodendroglioma. Neurol Sci. Sep 17 2011;[Medline].

  2. Roldan G, Scott J, George D, Parney I, Easaw J, Cairncross G. Leptomeningeal disease from oligodendroglioma: clinical and molecular analysis. Can J Neurol Sci. May 2008;35(2):204-9. [Medline].

  3. Li S, Yan C, Huang L, Qiu X, Wang Z, Jiang T. Molecular prognostic factors of anaplastic oligodendroglial tumors and its relationship: a single institutional review of 77 patients from China. Neuro Oncol. Jan 2012;14(1):109-16. [Medline]. [Full Text].

  4. Megyesi JF, Kachur E, Lee DH, et al. Imaging correlates of molecular signatures in oligodendrogliomas. Clin Cancer Res. Jul 1 2004;10(13):4303-6. [Medline].

  5. Brown R, Zlatescu M, Sijben A, Roldan G, Easaw J, Forsyth P. The use of magnetic resonance imaging to noninvasively detect genetic signatures in oligodendroglioma. Clin Cancer Res. Apr 15 2008;14(8):2357-62. [Medline].

  6. Yuen ST, Fung CF, Ng TH, Leung SY. Central neurocytoma: its differentiation from intraventricular oligodendroglioma. Childs Nerv Syst. Oct 1992;8(7):383-8. [Medline].

  7. Burger PC, Rawlings CE, Cox EB, et al. Clinicopathologic correlations in the oligodendroglioma. Cancer. Apr 1 1987;59(7):1345-52. [Medline].

  8. van den Bent MJ. Advances in the biology and treatment of oligodendrogliomas. Curr Opin Neurol. Dec 2004;17(6):675-80. [Medline].

  9. [Best Evidence] van den Bent MJ, Carpentier AF, Brandes AA, Sanson M, Taphoorn MJ, Bernsen HJ, et al. Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: a randomized European Organisation for Research and Treatment of Cancer phase III trial. J Clin Oncol. Jun 20 2006;24(18):2715-22. [Medline].

  10. Cairncross G, Macdonald D, Ludwin S, et al. Chemotherapy for anaplastic oligodendroglioma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. Oct 1994;12(10):2013-21. [Medline].

  11. 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. Jul 1 2003;21(13):2525-8. [Medline]. [Full Text].

  12. Mohile NA, Forsyth P, Stewart D, Raizer JJ, Paleologos N, Kewalramani T, et al. A phase II study of intensified chemotherapy alone as initial treatment for newly diagnosed anaplastic oligodendroglioma: an interim analysis. J Neurooncol. Sep 2008;89(2):187-93. [Medline].

  13. Cairncross JG, Berkey B, Shaw E. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendrogliomas: intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol. 2006;24:2702-2714.

  14. Daumas-Duport C, Scheithauer BW, Chodkiewicz JP, et al. Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases. Neurosurgery. Nov 1988;23(5):545-56. [Medline].

  15. Bello MJ, Vaquero J, de Campos JM, et al. Molecular analysis of chromosome 1 abnormalities in human gliomas reveals frequent loss of 1p in oligodendroglial tumors. Int J Cancer. Apr 15 1994;57(2):172-5. [Medline].

  16. Celli P, Nofrone I, Palma L, et al. Cerebral oligodendroglioma: prognostic factors and life history. Neurosurgery. Dec 1994;35(6):1018-34; discussion 1034-5. [Medline].

  17. Han SR, Yoon SW, Yee GT, Choi CY, Lee DJ, Sohn MJ, et al. Extraneural metastases of anaplastic oligodendroglioma. J Clin Neurosci. Aug 2008;15(8):946-9. [Medline].

  18. Hartmann C, von Deimling A. Oligodendrogliomas: impact of molecular genetics on treatment. Neurol India. Jun 2005;53(2):140-8. [Medline].

  19. Kang SG, Kim JH, Nam do H, Park K. Clinical and radiological prognostic factors of anaplastic oligodendroglioma treated by combined therapy. Neurol Med Chir (Tokyo). May 2005;45(5):232-8; discussion 238-9. [Medline].

  20. Kaye AH, Laws ER Jr, eds. Brain Tumors: An Encyclopedic Approach. New York: Churchill Livingstone; 1995:479-91.

  21. Kleihus P, Cavenee WK. Pathology and Genetics of Tumours of the Nervous System. New York: Oxford University Press; 2000:56-64.

  22. Mason WP. Oligodendroglioma. Curr Treat Options Neurol. Jul 2005;7(4):305-314. [Medline].

  23. Mason WP, DeAngelis LM. Procarbazine, CCNU, vincristine (PCV) chemotherapy for benign oligodendroglioma. Neurology. 1994;44(Suppl 2):A262-A263.

  24. Packer RJ, Sutton LN, Rorke LB, et al. Oligodendroglioma of the posterior fossa in childhood. Cancer. Jul 1 1985;56(1):195-9. [Medline].

  25. Paleologos NA, Vick NA, Kachoris JP. Chemotherapy for low grade oligodendrogliomas. Ann Neurol. 1994;36:294-295.

  26. Pitt MA, Jones AW, Reeve RS, Cowie RA. Oligodendroglioma of the fourth ventricle with intracranial and spinal oligodendrogliomatosis: a case report. Br J Neurosurg. 1992;6(4):371-4. [Medline].

  27. Sarkar C, Roy S, Tandon PN. Oligodendroglial tumors. An immunohistochemical and electron microscopic study. Cancer. May 1 1988;61(9):1862-6. [Medline].

  28. Schold SC, Burger PC, Minna JD, et al. Primary Tumors of the Brain and Spinal Cord. Boston: Butterworth Heinemann; 1997:71-82.

  29. van den Bent MJ, Afra D, de Witte O, et al. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet. Sep 17-23 2005;366(9490):985-90. [Medline].

  30. Wen PY, Black PM. Brain Tumors in Adults. Neurol Clin. 1995;13:861-873.

 
Previous
Next
 
Classic histologic image of oligodendroglioma. This image shows monomorphous tumoral proliferation that consists of round, regular cells with a small, central, hyperchromatic nucleus surrounded by clear cytoplasm. Few calcifications are present.
Smear preparation of anaplastic oligodendroglioma. This image reveals increased nuclear pleomorphism and vascular proliferation.
Contrast-enhanced computed tomography scan in a 44-year-old man with a 3-year history of epileptic seizures. This image reveals a calcified hypoattenuating lesion that is invading the corpus callosum.
Computed tomography scan of a low-grade oligodendroglioma. This image reveals a well-demarcated, left frontal hypoattenuating lesion with a small calcification.
Sagittal gadolinium-enhanced T1-weighted magnetic resonance image of a low-grade oligodendroglioma. This image demonstrates no contrast enhancement.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.