Oligodendroglioma medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The predominant therapy for oligodendroglioma is surgical resection. Adjunctive chemotherapy and radiation are required. | The predominant therapy for oligodendroglioma is surgical resection. Adjunctive chemotherapy and radiation are required. Supportive therapy for oligodendroglioma includes [[anticonvulsants]] and [[corticosteroids]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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===Radiotherapy=== | ===Radiotherapy=== | ||
*[[Radiation|Post-operative radiotherapy]] is recommended among all patients who 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> | *[[Radiation|Post-operative radiotherapy]] is recommended among all patients who 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> | ||
*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=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 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> | ||
*External beam radiation therapy is usually administered in standard fractions of 1.8–2 Gy and can 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 fractions of 1.8–2 Gy and can 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=== | ||
*[[Chemotherapy]] is indicated as adjuvant therapy for 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> | *[[Chemotherapy]] is indicated as adjuvant therapy for 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> | ||
*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> | *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> | ||
*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> | *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, 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> | *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> | ||
*[[Temozolomide]] ([[Temodar]]) is the preferred drug for the treatment of 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> | *[[Temozolomide]] ([[Temodar]]) is the preferred drug for the treatment of 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 preferred combination chemotherapy for [[anaplastic|anaplastic 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="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> | *[[PCV regimen|PCV 3 regimen]] is the preferred combination chemotherapy for [[anaplastic|anaplastic 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="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 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 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> | *Other chemotherapeutic drugs that may be used for the 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]] | **[[Carmustine]] | ||
**[[Cisplatin]] | **[[Cisplatin]] | ||
| Line 32: | Line 32: | ||
**[[Methotrexate]] ([[intrathecal|intrathecally]]) | **[[Methotrexate]] ([[intrathecal|intrathecally]]) | ||
**Diaziquone | **Diaziquone | ||
*If oligodendroglioma 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</ref> | *If oligodendroglioma 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</ref> | ||
**[[Tamoxifen]] | **[[Tamoxifen]] | ||
**[[Carboplatin]] | **[[Carboplatin]] | ||
| Line 38: | Line 38: | ||
===Supportive treatment=== | ===Supportive treatment=== | ||
*Supportive therapy for oligodendroglioma includes [[anticonvulsants]] and [[corticosteroids]], which focuses on relieving symptoms and improving the patient’s neurologic function.<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> | *Supportive therapy for oligodendroglioma includes [[anticonvulsants]] and [[corticosteroids]], which focuses on relieving symptoms and improving the patient’s neurologic function.<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> | ||
**[[Anticonvulsants]] are administered to the patients who have a [[seizure]]. [[Phenytoin]] given concurrently with [[radiation]] may have serious skin reactions such as [[erythema multiforme]] and [[Stevens-Johnson syndrome]]. | **[[Anticonvulsants]] are administered to the patients who have a [[seizure]]. [[Phenytoin]] given concurrently with [[radiation]] may have serious skin reactions such as [[erythema multiforme]] and [[Stevens-Johnson syndrome]]. | ||
**[[Corticosteroids]], usually [[dexamethasone]] given 4-10 mg every 4-6 h, can reduce peritumoral [[edema]], diminish mass effect, and lower [[intracranial pressure]] with a decrease in symptoms ([[headache]] or [[drowsiness]]). | **[[Corticosteroids]], usually [[dexamethasone]] given 4-10 mg every 4-6 h, can reduce peritumoral [[edema]], diminish mass effect, and lower [[intracranial pressure]] with a decrease in symptoms ([[headache]] or [[drowsiness]]). | ||
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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
The medical therapy of oligodendroglioma includes:
Radiotherapy
- Post-operative radiotherapy is recommended among all patients who develop oligodendroglioma.[1]
- 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.[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.[2]
Chemotherapy
- Chemotherapy is indicated as adjuvant therapy for oligodendroglioma.[1]
- Oligodendroglioma responds better to chemotherapy than astrocytoma of comparable grade.[3]
- Oligodendroglioma is the most chemosensitive of all the glial tumors.[4]
- Symptomatic, aggressive, enlarging, enhancing, and non-anaplastic oligodendrogliomas respond better to chemotherapy.[5]
- Temozolomide (Temodar) is the preferred drug for the treatment of oligodendroglioma.[1]
- PCV 3 regimen is the preferred combination chemotherapy for anaplastic oligodendroglioma.[1][6]
- 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.[7]
- Other chemotherapeutic drugs that may be used for the treatment of oligodendroglioma include:[8][4]
- If oligodendroglioma is unresponsive to the chemotherapeutic drugs used in earlier treatments or if it recurs, other drugs that may be used include:[8]
Supportive treatment
- Supportive therapy for oligodendroglioma includes anticonvulsants and corticosteroids, which focuses on relieving symptoms and improving the patient’s neurologic function.[1]
- Anticonvulsants are administered to the patients who have a seizure. Phenytoin given concurrently with radiation may have serious skin reactions such as erythema multiforme and Stevens-Johnson syndrome.
- Corticosteroids, usually dexamethasone given 4-10 mg every 4-6 h, can reduce peritumoral edema, diminish mass effect, and lower intracranial pressure with a decrease in symptoms (headache or drowsiness).
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
- ↑ 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.
- ↑ 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). - ↑ 4.0 4.1 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.
- ↑ 8.0 8.1 Chemotherapeutic drugs in malignant gliomas. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/treatment/chemotherapy/?region=on