A role for preirradiation PCV chemotherapy for oligodendroglial brain tumors

• Published in: Journal of neurology Vol. 247; no. 4; pp. 297 - 302
• Main Authors: STREFFER, J, SCHABET, M, BAMBERG, M, GROTE, E. H, MEYERMANN, R, VOIGT, K, DICHGANS, J, WELLER, M
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.04.2000; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Antineoplastic agents; Antineoplastic Agents, Alkylating - administration & dosage; Antineoplastic Agents, Alkylating - adverse effects; Antineoplastic Agents, Phytogenic - administration & dosage; Antineoplastic Agents, Phytogenic - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Brain Neoplasms - drug therapy; Brain Neoplasms - pathology; Brain Neoplasms - radiotherapy; Chemotherapy; Disease-Free Survival; Female; Humans; Lomustine - administration & dosage; Lomustine - adverse effects; Male; Medical sciences; Middle Aged; Neurology; Oligodendroglioma - drug therapy; Oligodendroglioma - pathology; Oligodendroglioma - radiotherapy; Pharmacology. Drug treatments; Procarbazine - administration & dosage; Procarbazine - adverse effects; Prospective Studies; Retrospective Studies; Time Factors; Tumors of the nervous system. Phacomatoses; Vincristine - administration & dosage; Vincristine - adverse effects; Antineoplastic agent; Human; Intracranial; Procarbazine; Nervous system diseases; Drug combination; Nitrosoureas; Malignant tumor; Vincristine; Cerebral disorder; Oligodendroglioma; Malignant glioma; Alkaloid; Chemotherapy; Treatment; Central nervous system disease; Lomustine
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s004150050587

Oligodendroglial tumors have been identified as a subgroup of glial neoplasms with a distinctly better response to chemotherapy and overall survival than purely astrocytic gliomas. Here we report our experience with adjuvant postirradiation and preirradiation chemotherapy using procarbazine, lomustine, and vincristine (PCV) in 27 patients with WHO grade II or III oligodendroglioma or oligoastrocytoma. The efficacy of chemotherapy was assessed according to the Macdonald response criteria (complete response, CR; partial response, PR; stable disease, SD; progressive disease, PD) and progression-free survival intervals by computed tomography or magnetic resonance imaging. First, we confirm that PCV salvage therapy for patients progressing after radiotherapy is highly effective (n = 11, 1 CR, 5 PR, 5 SD; median progression-free survival has not yet been reached, but is longer than 18 months). Second, 3 patients who received radiotherapy plus PCV as first-line therapy achieved CR and 2 achieved SD, and all 5 are progression-free with a median follow-up of 12 months. Third, given these encouraging results, 11 patients received postoperative preirradiation PCV chemotherapy and were given radiotherapy only upon progression. Preirradiation PCV chemotherapy was also effective (2 CR, 3 PR, 6 SD; median progression-free survival has not been yet reached, but is longer than 14 months). Patients with anaplastic oligoastrocytomas were as likely to respond to PCV chemotherapy, as were patients with anaplastic oligodendroglioma. Three patients who had previously responded to PCV were successfully treated with a second course of PCV upon recurrence. PCV chemotherapy was also effective in patients with leptomeningeal spread of oligodendrogliomas. A randomized prospective trial is required to compare the effectiveness and neurotoxicity of first-line PCV chemotherapy followed by radiotherapy to the traditional reverse sequence.