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Deferred radiotherapy and upfront procarbazine–ACNU–vincristine administration for 1p19q codeleted oligodendroglial tumors are associated with favorable outcome without compromising patient performance, regardless of WHO grade

Authors Hata N, Yoshimoto K, Hatae R, Kuga D, Akagi Y, Suzuki SO, Iwaki T, Shono T, Mizoguchi M, Iihara K

Received 27 June 2016

Accepted for publication 23 September 2016

Published 17 November 2016 Volume 2016:9 Pages 7123—7131


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ru Chen

Peer reviewer comments 3

Editor who approved publication: Professor Min Li

Nobuhiro Hata,1,2 Koji Yoshimoto,1 Ryusuke Hatae,1 Daisuke Kuga,1 Yojiro Akagi,1 Satoshi O Suzuki,3 Toru Iwaki,3 Tadahisa Shono,1,4 Masahiro Mizoguchi,1,5 Koji Iihara1

1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 2Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 3Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, 4Department of Neurosurgery, Harasanshin Hospital, Fukuoka, 5Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

Abstract: Recently updated phase III trials revealed the favorable effect of add-on procarbazine-lomustine-vincristine chemotherapy (CT) to radiotherapy (RT) in treating anaplastic oligodendrogliomas with 1p19q codeletion (codel). However, the underlying rationality of deferring RT and upfront CT administration for these tumors is yet to be elucidated. Here, we retrospectively analyzed the long-term outcome of our case series with oligodendroglial tumors treated with deferred RT and upfront procarbazine+nimustine+vincristine (PAV) in the introduction administration. We enrolled 36 patients with newly diagnosed oligodendroglial tumors (17, grade II and 19, grade III) treated during 1999–2012 and followed up for a median period of 69.0 months. Their clinical and genetic prognostic factors were analyzed, and progression-free survival, overall survival (OS), and deterioration-free survival (DFS) were evaluated. Regardless of the WHO grade, the 25 patients with 1p19q codel tumors never received RT initially, and of these 25, 23 received PAV treatment upfront. The 75% OS of patients with 1p19q codel tumor was 135.3 months (did not reach the median OS), indicating a favorable outcome. Multivariate analysis revealed that IDH mutation and 1p19q, not WHO grade, are independent prognostic factors; furthermore, IDH and 1p19q status stratified the cohort into 3 groups with significantly different OS. The DFS explained the prolonged survival without declining performance in patients with both grade II and III 1p19q codel tumors. Deferred RT and upfront PAV treatment for 1p19q codel oligodendrogliomas were associated with favorable outcomes without compromising performance status, regardless of WHO grade.

Keywords: oligodendroglioma, IDH, PAV, 1p19q codel

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