Oligodendroglioma
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| Oligodendroglioma | |
| ICD-10 | C71 |
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| ICD-9 | 191.9 |
| ICD-O: | 9450/3-9451/3 |
| DiseasesDB | 29450 |
| MeSH | D009837 |
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Oligodendroglioma Microchapters |
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Oligodendroglioma On the Web |
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American Roentgen Ray Society Images of Oligodendroglioma |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]
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Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating Oligodendroglioma
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
Molecular genetics
By far, the most common structural deformity found is co-deletion of chromosomal arms 1p and 19q. The high frequency of co-deletion (60-80%) is a striking feature of this glial tumour, and is considered as a "genetic signature" of oligodendroglioma. 1p/19q deletion has been correlated with both chemosensitivity and improved prognosis in oligodendrogliomas.[1][2] A t(1;19)(q10;p10) translocation mediates the combined deletions of 1p and 19q. The gene products lost as a consequence of this codeletion may include mediators of resistance to genotoxic therapies. Alternatively, 1p/19q loss might be an early oncogenic lesion promoting the formation of glial neoplasms, which retain high sensitivity to genotoxic stress.
Prognosis & treatment
Oligodendrogliomas are generally felt to be incurable using current treatments. However compared to the more common astrocytomas, they are slowly growing with prolonged survival. In one series, median survival times for oligodendrogliomas were 11.6 years for grade II and 3.5 years for grade III.[3] Because of the indolent nature of these tumors and the potential morbidity associated with neurosurgery, chemotherapy and radiation therapy, most neurooncologists will initially pursue a course of watchful waiting and treat patients symptomatically. Symptomatic treatment often includes the use of anticonvulsants for seizures and steroids for brain swelling. PCV chemotherapy (Procarbazine, CCNU and Vincristine) has been shown to be effective and is currently the most commonly used chemotherapy regimen used for treating anaplastic oligodendrogliomas.[4] Temozolomide is a common chemotheraputic drug to which oligodendrogliomas appear to be quite sensitive. It is often used as a first line therapy.
Because of their diffusely infiltrating nature, oligodendrogliomas cannot be completely resected and are not curable by surgical excision. If the tumor mass compresses adjacent brain structures, a 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.
Long-term survival is reported in a minority of patients.[5] With aggressive treatment and close monitoring, it is possible to outlive the typical life expectancies for both low grade and high grade oligodendrogliomas. In rare cases, patients have survived for up to fifteen years post-diagnosis. Westergaard’s study (1997) showed that patients younger than 20 years had a median survival of 17.5 years.[6] Another study shows a 34% survival rate after 20 years. [7]
References
- ↑ Laigle-Donadey F, Benouaich-Amiel A, Hoang-Xuan K, Sanson M (2005). "[Molecular biology of oligodendroglial tumors]". Neuro-Chirurgie (in French). 51 (3-4 Pt 2): 260–8. PMID 16292170.
- ↑ Walker C, Haylock B, Husband D; et al. (2006). "Clinical use of genotype to predict chemosensitivity in oligodendroglial tumors". Neurology. 66 (11): 1661–7. doi:10.1212/01.wnl.0000218270.12495.9a. PMID 16769937.
- ↑ Ohgaki H, Kleihues P. Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol. 2005 Jun;64(6):479-89. PMID: 15977639
- ↑ Herbert H. Engelhard, M.D., Ph.D., Ana Stelea, M.D., and Arno Mundt, M.D.[1] p.452
- ↑ Tatter SB. Recurrent malignant glioma in adults. Curr Treat Options Oncol. 2002 Dec;3(6):509-24. PMID: 12392640,
- ↑ Herbert H. Engelhard, M.D., Ph.D., Ana Stelea, M.D., and Arno Mundt, M.D.[2] p.449
- ↑ Feigenberg SJ, Amdur RJ, Morris CG, Mendenhall WM, Marcus RB, Friedman WA (2003). "Oligodendroglioma: does deferring treatment compromise outcome?". Am. J. Clin. Oncol. 26 (3): e60–6. doi:10.1097/01.COC.0000072507.25834.D6. PMID 12796617.
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