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Lowgradegliom 150618162917 Lva1 App6891
Lowgradegliom 150618162917 Lva1 App6891
Multimodal treatment
Most oligoastrocytomas and 50% to 75% of oligodendrogliomas
recur as AAs or GBM.
MRI Findings:
Hypo-intense on T1,
Hyper-intense on T2/FLAIR ,
Non-enhancing,
Well-circumscribed, solid SOL,
Size- 5.5x6 cm,
Not crossing midline.
Surgery:
Maximum Safe Resection
Images:
A: T1 Non Contrast
B: T2
C:T1 Contrast
HP:
Mixed Oligoastrocytoma; WHO Grade II
IHC:
1p&19q Codeleted
Postop MRI:
Small residual disease with moderate perilesional edema & P/O
Changes.
Now what?
Questions needed to be addressed:
2] Dose of RT?
3] RT Alone or RT + Chemotherapy?
Evidence
Phase III adult low grade glioma trials (EORTC 22844 and
22845): Risk Factors identified & Validated
Age>40 years
Size>6cm
Crossing Midline
Pure Astrocytoma histology
Neurological deficit before Surgery
Astrocytoma histology
Residual tumor of >/=1 cm on Postop MR
Pre-operative tumor diameter of >/=4 cm
Patients with:
All three unfavourable factors- PFS at 5years 13%
None of the three factors- PFS at 5years 70%
So, on the basis of above data
Evidence
Evidence
1p-19q codeletion, MGMT promoter methylation, and IDH mutation (p = 0.01) were
correlated with a higher rate of response to temozolomide
EORTC 22033-26033/CE5 phase III randomized trial for low
grade glioma: Phase III EORTC 22033-26033/NCIC CE5 intergroup
trial compares 50.4 Gy radiotherapy with up-front temozolomide
in previously untreated low-grade glioma
(Open to accrual)
Conclusion:
Procarbazine - Infertility
Options Include