Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2012-09-01
Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802.
Abstract
Purpose
A prior Radiation Therapy Oncology Group (RTOG) clinical trial in anaplastic oligodendroglioma suggested a progression-free survival benefit for procarbazine, lomustine, and vincristine (PCV) chemotherapy in addition to radiation therapy (RT), as have smaller trials in low-grade glioma (LGG).
Patients and methods
Eligibility criteria included supratentorial WHO grade 2 LGG, age 18 to 39 years with subtotal resection/biopsy, or age ≥ 40 years with any extent resection. Patients were randomly assigned to RT alone or RT followed by six cycles of PCV. Survival was compared by using the modified Wilcoxon and log-rank tests.
Results
In all, 251 patients were accrued from 1998 to 2002. Median overall survival (OS) time and 5-year OS rates for RT versus RT + PCV were 7.5 years versus not reached and 63% versus 72%, respectively (hazard ratio [HR]; 0.72; 95% CI, 0.47 to 1.10; P = .33; log-rank P = .13). Median progression-free survival (PFS) time and 5-year PFS rates for RT versus RT + PCV were 4.4 years versus not reached and 46% versus 63%, respectively (HR, 0.6; 95% CI, 0.41 to 0.86; P = .06; log-rank P = .005). OS and PFS were similar for all patients between years 0 and 2. After 2 years, OS and PFS curves separated significantly, favoring RT + PCV. For 2-year survivors (n = 211), the probability of OS for an additional 5 years was 74% with RT + PCV versus 59% with RT alone (HR, 0.52; 95% CI, 0.30 to 0.90; log-rank P = .02).
Conclusion
PFS but not OS was improved for adult patients with LGG receiving RT + PCV versus RT alone. On post hoc analysis, for 2-year survivors, the addition of PCV to RT conferred a survival advantage, suggesting a delayed benefit for chemotherapy.
Related Questions
Which molecular pathology findings make an oligodendroglioma too risky for upfront vorasidenib, or which other clinical characteristics do?
I still predominantly use grade/proliferation/presence of enhancement (would be more likely to use vorasidenib in a grade 2 nonenhancing tumor) as well as clinical criteria similar to those used in Pignatti et al., PMID 11956268, or large trials like RTOG 9802 (size at diagnosis, spread across midli...
How do you approach treatment of 1p19q non-codeleted high grade gliomas?
The question focuses on the management of 1p19q non-codeleted high-grade gliomas, which for all practical purposes translates roughly to the entity that by legacy terminology has been referred to as anaplastic astrocytoma. This question has come into focus with the recent publication of results of t...
How do you approach treatment of an IDH wild-type low-grade astrocytoma in an elderly patient?
Inherent in this good question are really two separate issues: 1) how to approach IDH-wt LGG and 2) how to treat glioma in the elderly (and/or frail).The first issue is addressed by the recent cIMPACT-NOW update #3 which states that in the presence of an IDH-wt gr 2-3 glioma, the presence of one of ...
How are the long term results of RTOG 9802 being incorporated into practice in the treatment of "high risk" low grade gliomas?
Answer was written along with Cleveland Clinic resident, Ehsan Balagamwala, MDThe decision to treat low grade gliomas (LGG) can be very challenging. At our institution, we typically utilize the EORTC risk factors to stratify our patients. EORTC high risk is defined as having 3 or more of the followi...
What dose and expansion of GTV is recommended for a low grade glioma?
I think doses between 45-54 Gy are probably reasonable for low grade gliomas when electing to treat with RT. Several studies have not shown a benefit with dose escalation in the treatment of low grade gliomas (EORTC 45 Gy vs 59.4 Gy; Intergroup 50.4 Gy vs 64.8 Gy). In terms of treatment volumes, RTO...
Is the criteria for RT + PCV for low grade glioma too narrow?
This is an excellent question, which unfortunately does not have a straightforward answer. The first and obvious answer is that 9802 evaluated patients older than 40 or less than 40 only if they had a subtotal resection, and therefore the specific benefit of RT+PCV in those less than 40 with a GTR c...