Oligodendroglioma medical therapy: Difference between revisions
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* 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]]. | * 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: | * 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. | *** 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]]. | *** [[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]]. | *** [[Surgical procedure]] that removes a [[bone]] flap, a [[section]] of the [[skull]], to [[Accessibility|access]] the [[brain]]. | ||
** '''Intensity-modulated | ** '''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]] | *** 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 | ** '''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. | *** 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]] | *** 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: | The [[Medical therapy template|medical therapy]] for [[oligodendroglioma]] includes: | ||
===Radiotherapy=== | ===Radiotherapy=== | ||
*[[Radiation|Post-operative radiotherapy]] is recommended among all [[patients]] who [[Development|develop]] [[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> | *[[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: | *[[Radiotherapy]] may not [[cure]] the [[cancer]] but it can: | ||
**[[Control]] the [[tumor]] | **[[Control]] the [[tumor]] | ||
**Delay [[Recurrence plot|recurrence]] | **Delay [[Recurrence plot|recurrence]] | ||
**Increase [[Survival analysis|survival]] | **Increase [[Survival analysis|survival]] | ||
*[[Radiation|External beam radiation therapy]] is [[Preferences|preferred]] to whole [[brain]] [[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> | *[[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> | *[[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> | ||
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**Diaziquone | **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> | *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]] | **[[Tamoxifen]] | ||
**[[Carboplatin]] | **[[Carboplatin]] | ||
**[[Etoposide]] | **[[Etoposide]] | ||
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:
- Brain tumors can be complex and require a combination of treatments for the best outcome.
- There is quite a wide range of treatments to meet the individual needs of each patient which includes standard therapies, precision medicine and clinical trials.
- Some of them are listed below:
- Brachytherapy:
- Destroys tumors by implanting radioactive medicine directly to or near the treatment site.
- Chemotherapy:
- Reaches cancer that may have spread, even microscopically, throughout the body.
- Craniotomy:
- Intensity-modulated radiation therapy:
- Minimally invasive cranial base surgery:
- Uses smaller incisions and specially designed instruments to eliminate a tumor while saving the surrounding tissue from damage.
- Stereotactic radiosurgery & radiotherapy:
- Brachytherapy:
The medical therapy for oligodendroglioma includes:
Radiotherapy
- Post-operative radiotherapy is recommended among all patients who develop oligodendroglioma.[1][2]
- Radiotherapy may not cure the cancer but it can:
- Control the tumor
- Delay recurrence
- Increase survival
- External beam radiation therapy is preferred to whole brain radiotherapy.[1]
- External beam radiation therapy is usually administered in standard fractions of 1.8–2 Gy and can reach a total dose of 60 Gy.[3]
Chemotherapy
- Chemotherapy is indicated as adjuvant therapy for oligodendroglioma.[1][4][5][6][7]
- Oligodendroglioma responds better to chemotherapy than astrocytoma of comparable grade.[8]
- Oligodendroglioma is the most chemosensitive of all the glial tumors.[9]
- Symptomatic, aggressive, enlarging, enhancing, and non-anaplastic oligodendrogliomas respond better to chemotherapy.[10]
- Temozolomide (Temodar) is the preferred drug for the treatment of oligodendroglioma.[1]
- PCV 3 regimen is the preferred combination chemotherapy for anaplastic oligodendroglioma which includes the following dosing schedule:[1][11]
- CCNU is administered on day 1
- Procarbazine is administered daily for 14 days beginning on day 8
- Vincristine is administered on days 8 and 29 of each 6-week cycle of therapy[12]
- Other chemotherapeutic drugs that may be used for the treatment of oligodendroglioma include:[13][9]
- If oligodendroglioma is unresponsive to the chemotherapeutic drugs used in earlier treatments or if it recurs, other drugs that may be used include:[13]
Supportive treatment
- Supportive therapy for oligodendroglioma focuses on relieving symptoms and improving the patient’s neurologic function and includes:[1]
- Anticonvulsants:
- Anticonvulsants are administered to the patients who have a seizure
- Phenytoin given concurrently with radiation may have serious skin reactions such as:
- Corticosteroids:
- Usually dexamethasone is given 4-10 mg every 4-6 h, which leads to:
- Reduced peritumoral edema
- Diminished mass effect
- Lower intracranial pressure with a decrease in symptoms (headache or drowsiness)
- Usually dexamethasone is given 4-10 mg every 4-6 h, which leads to:
References
- ↑ 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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). - ↑ 9.0 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.
- ↑ Cairncross JG, Macdonald DR, Ramsay DA (1992). "Aggressive oligodendroglioma: a chemosensitive tumor". Neurosurgery. 31 (1): 78–82. PMID 1641113.
- ↑ 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.
- ↑ 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.
- ↑ 13.0 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