Revised: Feb. 2004
Unlike most astrocytomas, these tumours have a higher response rate to chemotherapy. Work by Cairncross et al (1) has suggested upwards of 70% of anaplastic oligodendrogliomas will respond to chemotherapy and the responses are often quite durable. Even low grade oligodendrogliomas seem to respond to chemotherapy. For this reason, studies are underway looking at adjuvant chemotherapy in this population. For recurrent disease, the most beneficial regimen in chemotherapy-naive patients is PCV combination (CCNU, procarbazine, vincristine). For patients who previously have received PCV chemotherapy, it appears combinations of platinum and etoposide have some activity (2). Surgical and radiation options remain unchanged for anaplastic tumours.
Low grade oligodendrogliomas may be treated up front with surgery alone, surgery with radiotherapy or surgery and PCV chemotherapy. Treatment at time of recurrence of these tumours will depend on prior therapy. Again, surgery should be strongly considered for late recurrences as differentiating from prior treatment effects and re-evaluating histology may be important
For all grades of histology of oligodendrogliomas and mixed oligoastrocytomas, there is interest in trials of new or alternative chemotherapy agents. Certainly patients who have failed after PCV chemotherapy should be considered for such trials.
References:
Cairncross G, MacDonald D, Ludwin S, et al. Chemotherapy for anaplastic oligodendroglioma. J Clin Oncol 12(10):2013-2021, 1994.
Peterson K, Paleologos N, Forsyth P, et al. Salvage chemotherapy for oligodendroglioma. J Neurosurg 85:597-601, 1996Peterson K, Paleologos N, Forsyth P, et al. Salvage chemotherapy for oligodendroglioma. J Neurosurg 85:597-601, 1996.
