Abstract
The time to tumor progression (TTP), time to death (TTD) and complications were studied prospectively in a cohort of patients treated by surgery and adjuvant radio- and intensified PCV chemotherapy for astrocytomas (AIII), oligodendrogliomas (OIII) and oligoastrocytomas (OAIII) WHO grade III. The treatment was carried out in 48 patients: 24 AIII, 20 OAIII and four OIII, at the same medical institution. OIII and OAIII were grouped together (OIIIOAIII). With the exception of age (mean age 48.5 years for AIII and 38.5 years for OIIIOAIII, respectively) and number of PCV cycles completed (median of three cycles for AIII and 4.75 for OIIIOAIII respectively), the patients' characteristics at study entry (gender, Karnofsky Performance Score (KPS), tumor localization) and at completion of therapy (extent of tumor resection, dose of adjuvant radiotherapy) were not statistically different between the two patient groups. The median TTP and TTD for AIII were 26.8 and 27.9 months, respectively. The median TTP and TTD for OIIIOAIII were not reached yet. The 75th percentile of TTP and TTD for OIIIOAIII was reached at 49.4 and 51.5 months, respectively. The Kaplan–Meier analysis showed significantly longer TTP (p = 0.009) and TTD (p = 0.002) for OIIIOAIII as compared to AIII. A new neurological deficit, following surgery, occurred in 14.5% of the patients. Brain radiation necrosis occurred in one patient. The most significant toxicity of PCV-chemotherapy was hematologic and reached WHO grade III and IV in 30% of the patients. This study compared for the first time the outcome of AIII with OIIIOAIII when treated with combined surgery, radiotherapy, and intensified PCV chemotherapy: longer TTP and TTD were observed in anaplastic glioma with oligodendroglial components WHO grade III as compared to pure astrocytoma WHO grade III. This is in accordance with results in patients treated by surgery with adjuvant radiation alone. The efficacy of additional adjuvant PCV chemotherapy in prolonging TTP and TTD has to be verified in prospective controlled studies.
Similar content being viewed by others
References
Fine HA, Dear KBG, Loeffler JS, Black P Mcl, Canellos GP: Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 71: 2575–2597, 1992
Huncharek M, Muscat J: Treatment of recurrent high grade astrocytoma; results of a systematic reviewof 1,415 patients. Anticancer Res 18: 1303–1312, 1998
Cairncross G, Macdonald D, Ludwin S, Lee D, Cascino T, Buckner J, Fulton D, Dropcho E, Stewart D, Schold C, Wainman N, Eisenhauer E: Chemotherapy for anaplastic oligodendroglioma. J Clin Oncol 12: 2013–2021, 1994
Levin VA, Silver P, Hannigan J, Wara WM, Gutin PH, Davis RL, Wilson CB: Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, Procarbazine, andVincristine (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiat Oncol Biol Phys 18: 321–324, 1990
Thomas DGT, Bleehen NM, Roberts JT, Abram P, Brada M, Lantos PL, Moss TH, Ironside JW, Whaley JB, Stenning SP: MRC Randomised trial of adjuvant chemotherapy in high grade glioma (HGG)-BR05. J Neuro-Oncol 39: 102, 1998 (abstract)
Cairncross G, Macdonald D: Successful chemotherapy for recurrent malignant oligodendroglioma. Ann Neurol 23: 360–364, 1988
Kleihues P, Cavenee WK: Pathology and genetics of tumours of the nervous system. In: Kleihues P, Cavenee WK (eds) World Health Organization Classification of Tumours, Iarc Press, Lyon, 2000
Shapiro WR, Young DF: Chemotherapy of malignant gliomas with CCNU alone and CCNU combined with Vincristine sulfate and Procarbazine hydrochloride. Trans Am Neurol Assoc 101: 217–220, 1976
Macdonald DR, Cascino TL, Schold SC: Response criteria for phase II studies of malignant Glioma. J Clin Oncol 8: 1277–1280, 1990
Ludwig CL, Smith MT, Bodfrey AD: A clinicopathological study of 323 patients with oligodendrogliomas. Ann Neurol 19: 15–21, 1986
Shaw EG, Scheithauer BW, O'Fallon JR, Tazelaar HD, Davis DH: Oligodendrogliomas: the Mayo Clinic experience. J Neurosurg 76: 428–434, 1992
Dupont WD, Plummer WD Jr: Power and sample size calculations. A review and computer program. Control Clin Trials 11: 116–128, 1990
Bent van den MJ, Kros JM, Heimans JJ, Pronk LC, van Groeningen CJ, Krouwer HG, Taphoorn MJ, Tonnenberg BA, Tijssen CC, Twijnstra A, Punt CJ, Boogerd W: Response rate and prognostic factors of recurrent oligodendroglioma treated with Procarbazine, CCNU, and Vincristine chemotherapy. Neurology 51: 1140–1145, 1998
Glass J, Hochberg FH, Gruber ML, Louis DN, Smith D, Ratiner B: The treatment of oligodendrogliomas and mixed oligodendroglioma-astrocytomas with PCV chemotherapy. J Neurosurg 76: 741–745, 1992
Kim L, Hochberg FH, Thornton AF, Harsh GR, Patel H, Finkelstein D, Louis DN: Procarbazine, Lomustine, andVincristine (PCV) chemotherapy for Grade III and Grade IV oligoastrocytomas. J Neurosurg 85: 602–607, 1996
Kyritsis AP, Yung WKA, Bruner J, Gleason MJ, Levin VA: The treatment of anaplastic oligodendrogliomas and mixed gliomas. Neurosurgery 32: 365–371, 1993
Soffietti R, Chiò A, Mocellini C, Mocellini C, Dudà R, Vigliani MC, Schiffer D: Response of oligodendroglial tumors to PCV chemotherapy. Neurology 44 (Suppl 2): A309, 1994 (abstract)
Jeressic B, Sibamoto Y, Gruijicic D: Combined treatment modality for anaplastic oligodendroglioma:Aphase II study. J Neuro-Oncol 43: 179–185, 1999
Mason WP, DeAngelis LM: Procarbazine, CCNU, Vincristine (PCV) chemotherapy (CT) for benign oligodendroglioma. Neurology 44 (Suppl 2): A262, 1994 (abstract)
Prados MD, Scott C, Curran WJ, Nelson DF, Leibel S, Kramer S: Procarbazine, Lomustine, and Vincristine (PCV) chemotherapy for anaplastic astrocytoma: A retrospective review of Radiation Therapy of Oncology Group protocols comparing survival with Carmustine or PCV adjuvant chemotherapy. J Clin Oncol 17: 3389–3395, 1999
Grant R, Liang B, Junk L: Chemotherapy response criteria in malignant glioma. Neurology 46: A474, 1996 (abstract)
Streffer J, Schabet M, Bamberg M, Grote EH, Meyermann R, Voigt K, Dichgans J, Weller M: A role of preirradiation PCV chemotherapy for oligodendroglial brain tumors. J Neurol 247: 297–302, 2000
Dropcho EJ, Soong SJ: The prognostic impact of prior low grade histology in patients with anaplastic gliomas: A case control study. Neurology 47: 684–690, 1996
Nazzaro JM, Neuwelt EA. The role of surgery in the management of supratentorial Intermediate and high-grade astrocytomas in adults. J Neurosurg 73: 331–344, 1890
Perry JR, Brown MT, Gockerman: Acute Leukemia following treatment of malignant Glioma. J Neuro-Oncol 40: 39–46, 1998
Postma TJ, van Groeningen CJ, Witjes RJ, Weerts JG, Kralendonk JH, Heimans JJ: Neurotoxicity of combination chemotherapy with Procarbazine, CCNU and Vincristine (PCV) for recurrent glioma. J Neuro-Oncol 38: 69–75, 1998
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kristof, R.A., Neuloh, G., Hans, V. et al. Combined Surgery, Radiation, and PCV Chemotherapy for Astrocytomas Compared to Oligodendrogliomas and Oligoastrocytomas WHO Grade III. J Neurooncol 59, 231–237 (2002). https://doi.org/10.1023/A:1019987116596
Issue Date:
DOI: https://doi.org/10.1023/A:1019987116596