Skip to main content
Log in

Combined Surgery, Radiation, and PCV Chemotherapy for Astrocytomas Compared to Oligodendrogliomas and Oligoastrocytomas WHO Grade III

  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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

    Google Scholar 

  2. Huncharek M, Muscat J: Treatment of recurrent high grade astrocytoma; results of a systematic reviewof 1,415 patients. Anticancer Res 18: 1303–1312, 1998

    Google Scholar 

  3. 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

    Google Scholar 

  4. 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

    Google Scholar 

  5. 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)

    Google Scholar 

  6. Cairncross G, Macdonald D: Successful chemotherapy for recurrent malignant oligodendroglioma. Ann Neurol 23: 360–364, 1988

    Google Scholar 

  7. 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

    Google Scholar 

  8. 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

    Google Scholar 

  9. Macdonald DR, Cascino TL, Schold SC: Response criteria for phase II studies of malignant Glioma. J Clin Oncol 8: 1277–1280, 1990

    Google Scholar 

  10. Ludwig CL, Smith MT, Bodfrey AD: A clinicopathological study of 323 patients with oligodendrogliomas. Ann Neurol 19: 15–21, 1986

    Google Scholar 

  11. Shaw EG, Scheithauer BW, O'Fallon JR, Tazelaar HD, Davis DH: Oligodendrogliomas: the Mayo Clinic experience. J Neurosurg 76: 428–434, 1992

    Google Scholar 

  12. Dupont WD, Plummer WD Jr: Power and sample size calculations. A review and computer program. Control Clin Trials 11: 116–128, 1990

    Google Scholar 

  13. 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

    Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    Google Scholar 

  16. Kyritsis AP, Yung WKA, Bruner J, Gleason MJ, Levin VA: The treatment of anaplastic oligodendrogliomas and mixed gliomas. Neurosurgery 32: 365–371, 1993

    Google Scholar 

  17. 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)

    Google Scholar 

  18. Jeressic B, Sibamoto Y, Gruijicic D: Combined treatment modality for anaplastic oligodendroglioma:Aphase II study. J Neuro-Oncol 43: 179–185, 1999

    Google Scholar 

  19. Mason WP, DeAngelis LM: Procarbazine, CCNU, Vincristine (PCV) chemotherapy (CT) for benign oligodendroglioma. Neurology 44 (Suppl 2): A262, 1994 (abstract)

    Google Scholar 

  20. 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

    Google Scholar 

  21. Grant R, Liang B, Junk L: Chemotherapy response criteria in malignant glioma. Neurology 46: A474, 1996 (abstract)

    Google Scholar 

  22. 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

    Google Scholar 

  23. 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

    Google Scholar 

  24. 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

    Google Scholar 

  25. Perry JR, Brown MT, Gockerman: Acute Leukemia following treatment of malignant Glioma. J Neuro-Oncol 40: 39–46, 1998

    Google Scholar 

  26. 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

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints 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

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1019987116596

Navigation