Combined surgery, radiation, and PCV chemotherapy for astrocytomas compared to oligodendrogliomas and oligoastrocytomas WHO grade III.

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.