Treatment of large low-grade oligodendroglial tumors with upfront procarbazine, lomustine, and vincristine chemotherapy with long follow-up: a retrospective cohort study with growth kinetics

J Neurooncol. 2015 Jan;121(2):365-72. doi: 10.1007/s11060-014-1641-9. Epub 2014 Oct 26.

Abstract

We treated patients with newly diagnosed and large low-grade oligodendroglial tumors with upfront procarbazine, CCNU and vincristine (PCV) in order to delay radiotherapy. Patients were treated with PCV for a maximum of 6 cycles. The response to treatment was defined according to the RANO criteria; in addition change over time of mean tumor diameters (growth kinetics) was calculated. Thirty-two patients were treated between 1998 and 2006, 18 of which were diagnosed with 1p/19q co-deleted tumors. Median follow-up duration was 8 years (range 0.5-13 years). The median overall survival (mOS) was 120 months and the median progression-free survival (mPFS) was 46 months. Growth kinetics showed an ongoing decrease of the mean tumor diameter after completion of chemotherapy, during a median time of 35 months, but an increase of the mean tumor diameter did not herald progression as detected by RANO criteria. 1p/19q co-deletion was associated with a significant increase in OS (mOS 83 months versus not reached for codeleted tumors; p = 0.003)) and PFS (mPFS 35 months versus 67 months for codeleted tumors; p = 0.024). Patients with combined 1p/19q loss had a 10 year PFS of 34 % and the radiotherapy in these patients was postponed for a median period of more than 6 years. This long-term follow-up study indicates that upfront PCV chemotherapy is associated with long PFS and OS and delays radiotherapy for a considerable period of time in patients with low-grade oligodendroglial tumors, in particular with combined 1p/19q loss.

MeSH terms

  • Adult
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Agents / toxicity
  • Brain Neoplasms / drug therapy*
  • Brain Neoplasms / pathology
  • Brain Neoplasms / physiopathology
  • Disease Progression
  • Drug Therapy, Combination / adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Lomustine / therapeutic use*
  • Lomustine / toxicity
  • Male
  • Middle Aged
  • Oligodendroglioma / drug therapy*
  • Oligodendroglioma / pathology
  • Oligodendroglioma / physiopathology
  • Procarbazine / therapeutic use*
  • Procarbazine / toxicity
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome
  • Tumor Burden
  • Vincristine / therapeutic use*
  • Vincristine / toxicity

Substances

  • Antineoplastic Agents
  • Procarbazine
  • Vincristine
  • Lomustine