Oligodendroglioma medical therapy: Difference between revisions

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{{CMG}}
{{Oligodendroglioma}}
{{Oligodendroglioma}}
{{CMG}}{{AE}}{{S.M.}}{{SR}}


==Overview==
==Overview==
Because of their diffusely infiltrating nature, oligodendrogliomas cannot be completely resected and are not curable by [[surgery|surgical excision]]. If the tumor mass compresses adjacent brain structures, a [[neurosurgery|neurosurgeon]] will typically remove as much of the tumor as he or she can without damaging other critical, healthy brain structures. Surgery may be followed up by [[chemotherapy]], [[radiation]], or a mix of both. Oligodendrogliomas, like all other infiltrating [[gliomas]], have a very high (almost uniform) rate of recurrence and gradually increase in grade over time.  Recurrent tumors are generally treated with more aggressive chemotherapy and radiation therapy. Recently, [[stereotactic surgery]] has proven successful in treating small tumors that have been diagnosed early.
The predominant [[therapy]] for [[oligodendroglioma]] is [[surgical resection]]. [[Adjuvant chemotherapy|Adjunctive chemotherapy]] and [[radiation]] are required. [[Support|Supportive]] [[therapy]] for [[oligodendroglioma]] includes [[anticonvulsants]] and [[corticosteroids]].


==Medical Therapy==
==Medical Therapy==
'''Innovative treatment options:'''
* [[Brain]] [[tumors]] can be [[Complex (chemistry)|complex]] and require a [[Combination therapy|combination of treatments]] for the [[Best practice|best]] [[outcome|outcome.]]
* There is quite a wide [[Range (statistics)|range]] of [[treatments]] to meet the [[Individual growth|individual]] needs of each [[patient]] which includes [[standard]] [[Therapy|therapies]], [[precision]] [[medicine]] and [[clinical trials]].
* Some of them are listed below:
**'''Brachytherapy:'''
*** Destroys [[tumors]] by [[Implant|implanting]] [[radioactive]] [[medicine]] [[Directly observed treatment|directly]] to or near the [[Treatments|treatment]] site.
** '''Chemotherapy:'''
*** [[Reachback|Reaches]] [[cancer]] that may have [[Spreading activation|spread]], even [[Microscopic|microscopically]], throughout the [[Human body|body]].
** '''Craniotomy:'''
*** [[Surgical procedure]] that removes a [[bone]] flap, a [[section]] of the [[skull]], to [[Accessibility|access]] the [[brain]].
** '''Intensity-modulated radiation therapy:'''
*** Uses [[Computer-assisted|computer]] technology to [[Delivery|deliver]] [[radiation treatment]] that precisely [[fits]] the [[Size consistency|size]] and [[Shape parameter|shape]] of the [[tumor]].
** '''Minimally invasive cranial base surgery:'''
*** Uses smaller [[Incision|incisions]] and specially [[Design matrix|designed]] [[Instrumental variable|instruments]] to eliminate a [[tumor]] while saving the surrounding [[tissue]] from damage.
** '''Stereotactic radiosurgery & radiotherapy:'''
*** A [[noninvasive]] [[procedure]] that applies [[Large-print|large]] [[doses]] of [[radiation]] [[Directly observed treatment|directly]] to a [[tumor]].
The [[Medical therapy template|medical therapy]] for [[oligodendroglioma]] includes:


===Radiotherapy===
===Radiotherapy===
Because of the indolent nature of these tumors and the potential [[morbidity]] associated with [[neurosurgery]], [[chemotherapy]] and [[radiation therapy]], most [[oncology|neurooncologists]] will initially pursue a course of [[watchful waiting]] and treat patients symptomatically.  Symptomatic treatment often includes the use of [[anticonvulsants]] for seizures and [[Glucocorticoid|steroids]] for [[oedema|brain swelling]].  PCV chemotherapy ([[Procarbazine]], [[Lomustine|CCNU]] and [[Vincristine]]) has been shown to be effective and is currently the most commonly used chemotherapy regimen used for treating anaplastic oligodendrogliomas.<ref>Herbert H. Engelhard, M.D., Ph.D., Ana Stelea, M.D., and Arno Mundt, M.D.[http://www.virtualtrials.com/pdf/oligo.pdf] p.452</ref> [[Temozolomide]] is a common chemotheraputic drug to which oligodendrogliomas appear to be quite sensitive.  It is often used as a first line therapy.
*[[Radiation|Post-operative radiotherapy]] is recommended among all [[patients]] who [[Development|develop]] [[oligodendroglioma|oligodendroglioma.]]<ref name="rx">Treatment of oligodendroglioma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/oligodendroglioma/?region=on</ref><ref name="pmid30988626">{{cite journal| author=Harat M, Blok M, Harat A, Soszyńska K| title=The impact of adjuvant radiotherapy on molecular prognostic markers in gliomas. | journal=Onco Targets Ther | year= 2019 | volume= 12 | issue=  | pages= 2215-2224 | pmid=30988626 | doi=10.2147/OTT.S200818 | pmc=6441459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30988626  }} </ref>
*[[Radiotherapy]] may not [[cure]] the [[cancer]] but it can:
**[[Control]] the [[tumor]]
**Delay [[Recurrence plot|recurrence]]
**Increase [[Survival analysis|survival]]
*[[Radiation|External beam radiation therapy]] is [[Preferences|preferred]] to whole [[brain]] [[radiotherapy|radiotherapy.]]<ref name="rx">Treatment of oligodendroglioma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/oligodendroglioma/?region=on</ref>
*[[External beam radiation therapy]] is usually administered in [[standard]] [[Fraction (chemistry)|fractions]] of 1.8–2 Gy and can [[Reachback|reach]] a total [[dose]] of 60 Gy.<ref name="pmid20555079">{{cite journal| author=Stupp R, Tonn JC, Brada M, Pentheroudakis G, ESMO Guidelines Working Group| title=High-grade malignant glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal=Ann Oncol | year= 2010 | volume= 21 Suppl 5 | issue=  | pages= v190-3 | pmid=20555079 | doi=10.1093/annonc/mdq187 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20555079  }} </ref>


===Chemotherapy===
===Chemotherapy===
*Oligodendroglioma responds better to chemotherapy than astrocytoma of comparable grade.<ref name="pmiddoi:10.1016/S0090-3019(03)00167-8">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi:10.1016/S0090-3019(03)00167-8 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*[[Chemotherapy]] is [[Indication (medicine)|indicated]] as [[adjuvant therapy]] for [[oligodendroglioma|oligodendroglioma.]]<ref name="rx">Treatment of oligodendroglioma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/oligodendroglioma/?region=on</ref><ref name="pmid9776413">{{cite journal| author=Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR et al.| title=Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. | journal=J Natl Cancer Inst | year= 1998 | volume= 90 | issue= 19 | pages= 1473-9 | pmid=9776413 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9776413  }} </ref><ref name="pmid23071247">{{cite journal| author=Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J et al.| title=Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. | journal=J Clin Oncol | year= 2013 | volume= 31 | issue= 3 | pages= 337-43 | pmid=23071247 | doi=10.1200/JCO.2012.43.2674 | pmc=3732012 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23071247  }} </ref><ref name="pmid23071237">{{cite journal| author=van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY et al.| title=Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. | journal=J Clin Oncol | year= 2013 | volume= 31 | issue= 3 | pages= 344-50 | pmid=23071237 | doi=10.1200/JCO.2012.43.2229 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23071237  }} </ref><ref name="pmid28263309">{{cite journal| author=Mohammad F, Weissmann S, Leblanc B, Pandey DP, Højfeldt JW, Comet I et al.| title=EZH2 is a potential therapeutic target for H3K27M-mutant pediatric gliomas. | journal=Nat Med | year= 2017 | volume= 23 | issue= 4 | pages= 483-492 | pmid=28263309 | doi=10.1038/nm.4293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28263309  }} </ref>
*[[Oligodendroglioma]] responds better to [[chemotherapy]] than [[astrocytoma]] of [[Comparability|comparable]] [[Grading (tumors)|grade.]]<ref name="pmiddoi:10.1016/S0090-3019(03)00167-8">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi:10.1016/S0090-3019(03)00167-8 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
*[[Oligodendroglioma]] is the most chemosensitive of all the [[glioma|glial tumors.]]<ref name="pmid3382171">{{cite journal| author=Cairncross JG, Macdonald DR| title=Successful chemotherapy for recurrent malignant oligodendroglioma. | journal=Ann Neurol | year= 1988 | volume= 23 | issue= 4 | pages= 360-4 | pmid=3382171 | doi=10.1002/ana.410230408 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3382171  }} </ref>
*[[Symptomatic]], aggressive, enlarging, [[Enhancer (genetics)|enhancing]], and non-[[anaplastic]] [[oligodendrogliomas]] respond better to [[chemotherapy|chemotherapy.]]<ref name="pmid1641113">{{cite journal| author=Cairncross JG, Macdonald DR, Ramsay DA| title=Aggressive oligodendroglioma: a chemosensitive tumor. | journal=Neurosurgery | year= 1992 | volume= 31 | issue= 1 | pages= 78-82 | pmid=1641113 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1641113  }} </ref>
*[[Temozolomide]] ([[Temodar]]) is the [[Preferences|preferred]] [[drug]] for the [[Treatments|treatment]] of [[oligodendroglioma|oligodendroglioma.]]<ref name="rx">Treatment of oligodendroglioma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/oligodendroglioma/?region=on</ref>
*[[PCV regimen|PCV 3 regimen]] is the [[Preferences|preferred]] [[Combination therapy|combination]] [[chemotherapy]] for [[anaplastic|anaplastic oligodendroglioma]] which includes the following [[dosing]] [[Schedule I|schedule]]:<ref name="rx">Treatment of oligodendroglioma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/oligodendroglioma/?region=on</ref><ref name="pmid12107116">{{cite journal| author=Mueller W, Hartmann C, Hoffmann A, Lanksch W, Kiwit J, Tonn J et al.| title=Genetic signature of oligoastrocytomas correlates with tumor location and denotes distinct molecular subsets. | journal=Am J Pathol | year= 2002 | volume= 161 | issue= 1 | pages= 313-9 | pmid=12107116 | doi=10.1016/S0002-9440(10)64183-1 | pmc=PMC1850690 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12107116  }} </ref>
**[[CCNU]] is administered on day 1
**[[Procarbazine]] is administered [[Daily Med|daily]] for 14 days beginning on day 8
**[[Vincristine]] is administered on days 8 and 29 of each 6-week [[Cycle (gene)|cycle]] of [[therapy]]<ref name="pmid7407756">{{cite journal| author=Levin VA, Edwards MS, Wright DC, Seager ML, Schimberg TP, Townsend JJ et al.| title=Modified procarbazine, CCNU, and vincristine (PCV 3) combination chemotherapy in the treatment of malignant brain tumors. | journal=Cancer Treat Rep | year= 1980 | volume= 64 | issue= 2-3 | pages= 237-44 | pmid=7407756 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7407756  }} </ref>
*Other [[Chemotherapeutic agent|chemotherapeutic drugs]] that may be used for the [[Treatments|treatment]] of [[oligodendroglioma]] include:<ref name="rxchemo">Chemotherapeutic drugs in malignant gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/treatment/chemotherapy/?region=on</ref><ref name="pmid3382171">{{cite journal| author=Cairncross JG, Macdonald DR| title=Successful chemotherapy for recurrent malignant oligodendroglioma. | journal=Ann Neurol | year= 1988 | volume= 23 | issue= 4 | pages= 360-4 | pmid=3382171 | doi=10.1002/ana.410230408 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3382171  }} </ref>
**[[Carmustine]]
**[[Cisplatin]]
**[[Erlotinib]]
**[[Hydroxyurea]]
**[[thioguanine|6-thioguanine]]
**[[Irinotecan]]
**[[Methotrexate]] ([[intrathecal|intrathecally]])
**Diaziquone
*If [[oligodendroglioma]] is [[unresponsive]] to the [[Chemotherapeutic agent|chemotherapeutic drugs]] used in earlier [[treatments]] or if it [[Recurrence plot|recurs]], other [[drugs]] that may be used include:<ref name="rxchemo">Chemotherapeutic drugs in malignant gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/treatment/chemotherapy/?region=on</ref>
**[[Tamoxifen]]
**[[Carboplatin]]
**[[Etoposide]]


===Supportive treatment===
*[[Support|Supportive]] [[therapy]] for [[oligodendroglioma]] [[Focusing|focuses]] on relieving [[symptoms]] and [[Improving agent|improving]] the [[Patient|patient’s]] [[Neurological|neurologic]] [[Function (biology)|function]] and includes:<ref name="rx" />
*[[Anticonvulsants]]:
**[[Anticonvulsants]] are administered to the [[patients]] who have a [[seizure]]
**[[Phenytoin]] given [[Concurrent overlap|concurrently]] with [[radiation]] may have [[Serious adverse event|serious]] [[skin]] [[Reactions on surfaces|reactions]] such as:
***[[Erythema multiforme]]
***[[Stevens-Johnson syndrome]]
*[[Corticosteroids]]:
**Usually [[dexamethasone]] is given 4-10 mg every 4-6 h, which [[Lead|leads]] to:
***[[Reduced]] peritumoral [[edema]]
***Diminished [[mass effect]]
***Lower [[intracranial pressure]] with a decrease in [[symptoms]] ([[headache]] or [[drowsiness]])


==References==
==References==
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Latest revision as of 14:23, 13 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]Sujit Routray, M.D. [3]

Overview

The predominant therapy for oligodendroglioma is surgical resection. Adjunctive chemotherapy and radiation are required. Supportive therapy for oligodendroglioma includes anticonvulsants and corticosteroids.

Medical Therapy

Innovative treatment options:

The medical therapy for oligodendroglioma includes:

Radiotherapy

Chemotherapy

Supportive treatment

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Treatment of oligodendroglioma. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/oligodendroglioma/?region=on
  2. ↑ Harat M, Blok M, Harat A, Soszyńska K (2019). "The impact of adjuvant radiotherapy on molecular prognostic markers in gliomas". Onco Targets Ther. 12: 2215–2224. doi:10.2147/OTT.S200818. PMC 6441459. PMID 30988626.
  3. ↑ Stupp R, Tonn JC, Brada M, Pentheroudakis G, ESMO Guidelines Working Group (2010). "High-grade malignant glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Ann Oncol. 21 Suppl 5: v190–3. doi:10.1093/annonc/mdq187. PMID 20555079.
  4. ↑ Cairncross JG, Ueki K, Zlatescu MC, Lisle DK, Finkelstein DM, Hammond RR; et al. (1998). "Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas". J Natl Cancer Inst. 90 (19): 1473–9. PMID 9776413.
  5. ↑ Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J; et al. (2013). "Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402". J Clin Oncol. 31 (3): 337–43. doi:10.1200/JCO.2012.43.2674. PMC 3732012. PMID 23071247.
  6. ↑ van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY; et al. (2013). "Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951". J Clin Oncol. 31 (3): 344–50. doi:10.1200/JCO.2012.43.2229. PMID 23071237.
  7. ↑ Mohammad F, Weissmann S, Leblanc B, Pandey DP, Højfeldt JW, Comet I; et al. (2017). "EZH2 is a potential therapeutic target for H3K27M-mutant pediatric gliomas". Nat Med. 23 (4): 483–492. doi:10.1038/nm.4293. PMID 28263309.
  8. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi:10.1016/S0090-3019(03)00167-8 Check |pmid= value (help).
  9. ↑ 9.0 9.1 Cairncross JG, Macdonald DR (1988). "Successful chemotherapy for recurrent malignant oligodendroglioma". Ann Neurol. 23 (4): 360–4. doi:10.1002/ana.410230408. PMID 3382171.
  10. ↑ Cairncross JG, Macdonald DR, Ramsay DA (1992). "Aggressive oligodendroglioma: a chemosensitive tumor". Neurosurgery. 31 (1): 78–82. PMID 1641113.
  11. ↑ Mueller W, Hartmann C, Hoffmann A, Lanksch W, Kiwit J, Tonn J; et al. (2002). "Genetic signature of oligoastrocytomas correlates with tumor location and denotes distinct molecular subsets". Am J Pathol. 161 (1): 313–9. doi:10.1016/S0002-9440(10)64183-1. PMC 1850690. PMID 12107116.
  12. ↑ Levin VA, Edwards MS, Wright DC, Seager ML, Schimberg TP, Townsend JJ; et al. (1980). "Modified procarbazine, CCNU, and vincristine (PCV 3) combination chemotherapy in the treatment of malignant brain tumors". Cancer Treat Rep. 64 (2–3): 237–44. PMID 7407756.
  13. ↑ 13.0 13.1 Chemotherapeutic drugs in malignant gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/treatment/chemotherapy/?region=on


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