Oligoastrocytoma medical therapy: Difference between revisions

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==Overview==
==Overview==
The predominant therapy for oligoastrocytoma is surgical resection. Adjunctive chemotherapy and radiation are required.<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref><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. Accessed on October 20, 2015</ref> Supportive therapy for oligodendroglioma includes [[anticonvulsants]] and [[corticosteroids]].<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
The predominant therapy for oligoastrocytoma is surgical resection. Adjunctive chemotherapy and radiation are required. Supportive therapy for oligoastrocytoma includes [[anticonvulsants]] and [[corticosteroids]].


==Medical Therapy==
==Medical Therapy==
Line 10: Line 10:


===Radiotherapy===
===Radiotherapy===
*[[Radiation|Post-operative radiotherapy]] is recommended among all patients who develop oligoastrocytoma.<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*[[Radiation|Post-operative radiotherapy]] is recommended among all patients who develop oligoastrocytoma.<ref name="pmid20425038">{{cite journal| author=Pouratian N, Schiff D| title=Management of low-grade glioma. | journal=Curr Neurol Neurosci Rep | year= 2010 | volume= 10 | issue= 3 | pages= 224-31 | pmid=20425038 | doi=10.1007/s11910-010-0105-7 | pmc=PMC2857752 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20425038  }} </ref><ref name="pmid18533376">{{cite journal| author=Chandana SR, Movva S, Arora M, Singh T| title=Primary brain tumors in adults. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 10 | pages= 1423-30 | pmid=18533376 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18533376  }} </ref><ref name="rxcanada">Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*Radiotherapy may not cure the cancer but can control the tumor, delay recurrence, and increase survival.
*Radiotherapy may not cure the cancer but can control the tumor, delay recurrence, and increase survival.
*[[Radiation|External beam radiation therapy]] is preferred to whole brain radiotherapy.<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*[[Radiation|External beam radiation therapy]] is preferred to whole brain radiotherapy.<ref name="rxcanada">Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*It may also be given as the main treatment, if [[surgery]] is not an option.
*It may also be given as the main treatment, if [[surgery]] is not an option.
*External beam radiation therapy is usually administered in standard fractions of 1.8–2 Gy and can reach a total dose in the range of 54–60 Gy.<ref name="pmid26251628">{{cite journal| author=Simonetti G, Gaviani P, Botturi A, Innocenti A, Lamperti E, Silvani A| title=Clinical management of grade III oligodendroglioma. | journal=Cancer Manag Res | year= 2015 | volume= 7 | issue=  | pages= 213-23 | pmid=26251628 | doi=10.2147/CMAR.S56975 | pmc=PMC4524382 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26251628 }} </ref>
*External beam radiation therapy is usually administered in standard fractions of 1.8–2 grays (Gy) and can reach a total dose in the range 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===
*[[Chemotherapy]] is indicated as adjuvant therapy for oligoastrocytoma.<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*[[Chemotherapy]] is indicated as adjuvant therapy for oligoastrocytoma.<ref name="pmid20425038">{{cite journal| author=Pouratian N, Schiff D| title=Management of low-grade glioma. | journal=Curr Neurol Neurosci Rep | year= 2010 | volume= 10 | issue= 3 | pages= 224-31 | pmid=20425038 | doi=10.1007/s11910-010-0105-7 | pmc=PMC2857752 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20425038 }} </ref><ref name="pmid18533376">{{cite journal| author=Chandana SR, Movva S, Arora M, Singh T| title=Primary brain tumors in adults. | journal=Am Fam Physician | year= 2008 | volume= 77 | issue= 10 | pages= 1423-30 | pmid=18533376 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18533376 }} </ref><ref name="rxcanada">Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</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>
*[[Temozolomide]] ([[Temodar]]) is the preferred drug for the treatment of oligoastrocytoma.<ref name="rxcanada">Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref><ref name="pmid15284265">{{cite journal| author=Hoang-Xuan K, Capelle L, Kujas M, Taillibert S, Duffau H, Lejeune J et al.| title=Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions. | journal=J Clin Oncol | year= 2004 | volume= 22 | issue= 15 | pages= 3133-8 | pmid=15284265 | doi=10.1200/JCO.2004.10.169 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15284265  }} </ref>
*Symptomatic, aggressive, enlarging, enhancing, and non-anaplastic oligodendrogliomas respond better to [[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>
*[[PCV regimen|PCV 3 regimen]] is the preferred combination chemotherapy for oligoastrocytoma.<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>
*[[Temozolomide]] ([[Temodar]]) is the preferred drug for the treatment of oligoastrocytoma.<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*[[PCV regimen|PCV 3 regimen]] is the preferred combination chemotherapy for oligoastrocytoma.
**[[CCNU]] is administered on day 1, [[procarbazine]] is administered daily for 14 days beginning on day 8, and [[vincristine]] is administered on days 8 and 29 of each 6-week 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>
**[[CCNU]] is administered on day 1, [[procarbazine]] is administered daily for 14 days beginning on day 8, and [[vincristine]] is administered on days 8 and 29 of each 6-week 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 drugs that may be used for the treatment of oligoastrocytoma 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. Accessed on October 20, 2015</ref>
*Other chemotherapeutic drugs that may be used for the treatment of oligoastrocytoma 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. Accessed on October 20, 2015</ref>
**[[Carmustine]]
**[[Carmustine]]
**[[Cisplatin]]
**[[Cisplatin]]
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**[[Irinotecan]]
**[[Irinotecan]]
**[[Methotrexate]] ([[intrathecal|intrathecally]])
**[[Methotrexate]] ([[intrathecal|intrathecally]])
*If oligoastrocytoma is unresponsive to the chemotherapeutic drugs used in earlier treatments or if it 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. Accessed on October 20, 2015</ref>
*If oligoastrocytoma is unresponsive to the chemotherapeutic drugs used in earlier treatments or if it 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. Accessed on October 20, 2015</ref>
**[[Tamoxifen]]  
**[[Tamoxifen]]
**[[Carboplatin]]
**[[Carboplatin]]
**[[Etoposide]]
**[[Etoposide]]
*The advanced mode of delivery of chemotherapeutic drugs to the brain 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. Accessed on October 20, 2015</ref>
**Intraventrical chemotherapy
**Interstitial chemotherapy
**Convection-enhanced delivery


===Supportive treatment===
===Supportive treatment===
Supportive therapy for oligoastrocytoma includes [[anticonvulsants]] and [[corticosteroids]], which focuses on relieving symptoms and improving the patient’s neurologic function. The types of supportive therapy that may be used are:<ref name=rxcanada>Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
Supportive therapy for oligoastrocytoma includes [[anticonvulsants]] and [[corticosteroids]], which focuses on relieving symptoms and improving the patient’s neurologic function. The types of supportive therapy that may be used are:<ref name="rxcanada">Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015</ref>
*[[Anticonvulsants]]
*[[Anticonvulsants]]
**These drugs prevent [[seizures]].
**These drugs prevent [[seizures]].
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Latest revision as of 03:13, 23 October 2019

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

Overview

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

Medical Therapy

The medical therapy of oligodendroglioma includes:

Radiotherapy

  • Post-operative radiotherapy is recommended among all patients who develop oligoastrocytoma.[1][2][3]
  • Radiotherapy may not cure the cancer but can control the tumor, delay recurrence, and increase survival.
  • External beam radiation therapy is preferred to whole brain radiotherapy.[3]
  • It may also be given as the main treatment, if surgery is not an option.
  • External beam radiation therapy is usually administered in standard fractions of 1.8–2 grays (Gy) and can reach a total dose in the range of 60 Gy.[4]

Chemotherapy

Supportive treatment

Supportive therapy for oligoastrocytoma includes anticonvulsants and corticosteroids, which focuses on relieving symptoms and improving the patient’s neurologic function. The types of supportive therapy that may be used are:[3]

References

  1. ↑ 1.0 1.1 Pouratian N, Schiff D (2010). "Management of low-grade glioma". Curr Neurol Neurosci Rep. 10 (3): 224–31. doi:10.1007/s11910-010-0105-7. PMC 2857752. PMID 20425038.
  2. ↑ 2.0 2.1 Chandana SR, Movva S, Arora M, Singh T (2008). "Primary brain tumors in adults". Am Fam Physician. 77 (10): 1423–30. PMID 18533376.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Treatment of mixed gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/mixed-glioma/?region=on. Accessed on October 20, 2015
  4. ↑ 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.
  5. ↑ Hoang-Xuan K, Capelle L, Kujas M, Taillibert S, Duffau H, Lejeune J; et al. (2004). "Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions". J Clin Oncol. 22 (15): 3133–8. doi:10.1200/JCO.2004.10.169. PMID 15284265.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 8.0 8.1 8.2 Chemotherapeutic drugs in malignant gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/treatment/chemotherapy/?region=on. Accessed on October 20, 2015


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