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. See Brain Cancer Treatment
Protocols for summarized information.

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 preradiation 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.
Shaw et al found that for oligodendroglioma patients with 2-year survival (more benign
tumors), the probability of overall survival for an additional 5 years was 74% with combination therapy
compared to 59% with radiotherapy alone.