eMedicine Specialties > Neurology > Neuro-oncology

Oligodendroglioma: Treatment & Medication

Author: ABM Salah Uddin, MD, Consulting Staff, Department of Internal Medicine, St Vincent's Hospital
Coauthor(s): Tambi Jarmi, MD, Resident Physician, Department of Internal Medicine, Carraway Methodist Medical Center
Contributor Information and Disclosures

Updated: May 4, 2009

Treatment

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.

  • Chemotherapy6
    • 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.7 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.8
    • 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.9
    • 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.10
    • 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).11
    • 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.

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.

Medication

The standard chemotherapeutic treatment for oligodendrogliomas is combination chemotherapy with PCV. While modifications of the timing and dosage of this regimen (increasing dose, decreasing time interval to every 6 wk), are beyond the scope of this article, interested readers can review the references cited in Bibliography. Physicians prescribing chemotherapy should be aware of the treatment regimens and monitoring required. PCV chemotherapy is administered every 6 weeks or 8 weeks for a total of 6 cycles. If the treatment should fail, radiation therapy, other clinical trials for recurrent gliomas, or other drugs may be considered.

PCV chemotherapy

This combination of agents inhibits cell growth and differentiation.


Procarbazine, lomustine (CCNU), vincristine

Oral chemotherapy drugs administered in combination (PCV) on a specific chemotherapeutic schedule.

Adult

Procarbazine: 60 mg/m2/d PO for 14 d
Vincristine: 2 mg IV twice per cycle
CCNU: 110 mg/m2 PO on first d of each cycle
Administer combination of 3 drugs on a specific chemotherapeutic schedule q6-8wk

Pediatric

Not established

Sympathomimetic amines, barbiturates, phenothiazines, alcohol, and other CNS depressants can increase toxicity; foods containing high amounts of tyramine can increase toxicity owing to weak monoamine oxidase properties; concurrent mitomycin-C may cause acute pulmonary reaction

Documented hypersensitivity; preexisting bone marrow aplasia

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Only a physician trained in the appropriate use of chemotherapy should administer these drugs; for details, please refer to standard oncology textbooks
Caution in preexisting renal or hepatic disease (reduce dose); caution in patients with severe cardiopulmonary or hepatic impairment and patients with preexisting neuromuscular disease

More on Oligodendroglioma

Overview: Oligodendroglioma
Differential Diagnoses & Workup: Oligodendroglioma
Treatment & Medication: Oligodendroglioma
Follow-up: Oligodendroglioma
Multimedia: Oligodendroglioma
References
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References

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Further Reading

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Keywords

oligodendroglioma, OD, LGO, anaplastic oligodendroglioma, glial brain tumor, intracranial tumors, low-grade oligodendrogliomas

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Contributor Information and Disclosures

Author

ABM Salah Uddin, MD, Consulting Staff, Department of Internal Medicine, 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.

Medical Editor

Amy A Pruitt, MD, Associate Professor of Neurology, University of Pennsylvania; 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, Professor, Department of Internal Medicine, Section of Neurology, Dartmouth Medical School; Chief, Neurology Service, White River Junction Veterans Medical Center
Stephen A Berman, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
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