Oligodendroglioma medical therapy: Difference between revisions
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===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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*[[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> | *[[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> | *[[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 | **[[CCNU]] is administered on day 1. | ||
**[[Procarbazine]] is administered [[Daily Med|daily]] for 14 days beginning on day 8 | **[[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> | **[[Vincristine]] is administered on days 8 and 29 of each 6-week [[Cycle (gene)|cycle]] of [[therapy|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> | *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]] | **[[Carmustine]] | ||
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*[[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" /> | *[[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]]: | ||
**[[Anticonvulsants]] are administered to the [[patients]] who have a [[seizure]] | **[[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: | **[[Phenytoin]] given [[Concurrent overlap|concurrently]] with [[radiation]] may have [[Serious adverse event|serious]] [[skin]] [[Reactions on surfaces|reactions]] such as: | ||
***[[Erythema multiforme]] | ***[[Erythema multiforme]] | ||
Revision as of 13:59, 5 June 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