Department of Clinical Neurosciences, Foothills Medical Centre, 1403 29th St NW, Calgary, Alberta, Canada T2N 2T9.
J Clin Oncol. 2013 Jan 20;31(3):337-43. doi: 10.1200/JCO.2012.43.2674. Epub 2012 Oct 15.
Anaplastic oligodendrogliomas, pure (AO) and mixed (anaplastic oligoastrocytoma [AOA]), are chemosensitive, especially if codeleted for 1p/19q, but whether patients live longer after chemoradiotherapy is unknown.
Eligible patients with AO/AOA were randomly assigned to procarbazine, lomustine, and vincristine (PCV) plus radiotherapy (RT) versus RT alone. The primary end point was overall survival (OS).
Two hundred ninety-one eligible patients were randomly assigned: 148 to PCV plus RT and 143 to RT. For the entire cohort, there was no difference in median survival by treatment (4.6 years for PCV plus RT v 4.7 years for RT; hazard ratio [HR] = 0.79; 95% CI, 0.60 to 1.04; P = .1). Patients with codeleted tumors lived longer than those with noncodeleted tumors (PCV plus RT: 14.7 v 2.6 years, HR = 0.36, 95% CI, 0.23 to 0.57, P < .001; RT: 7.3 v 2.7 years, HR = 0.40, 95% CI, 0.27 to 0.60, P < .001), and the median survival of those with codeleted tumors treated with PCV plus RT was twice that of patients receiving RT (14.7 v 7.3 years; HR = 0.59; 95% CI, 0.37 to 0.95; P = .03). For those with noncodeleted tumors, there was no difference in median survival by treatment arm (2.6 v 2.7 years; HR = 0.85; 95% CI, 0.58 to 1.23; P = .39). In Cox models that included codeletion status, the adjusted OS for all patients was prolonged by PCV plus RT (HR = 0.67; 95% CI, 0.50 to 0.91; P = .01).
For the subset of patients with 1p/19q codeleted AO/AOA, PCV plus RT may be an especially effective treatment, although this observation was derived from an unplanned analysis.
间变性少突胶质细胞瘤，纯（AO）和混合（间变性少突星形细胞瘤[AOA]），对化疗敏感，尤其是 1p/19q 缺失者，但化疗和放疗后患者的生存时间是否更长尚不清楚。
符合条件的 AO/AOA 患者被随机分配至洛莫司汀、长春新碱和丙卡巴肼（PCV）联合放疗（RT）组或单独 RT 组。主要终点为总生存期（OS）。
291 例符合条件的患者被随机分组：148 例接受 PCV 联合 RT，143 例接受 RT。对于整个队列，治疗组的中位生存时间无差异（PCV 联合 RT 为 4.6 年，RT 为 4.7 年；风险比[HR] = 0.79；95%CI，0.60 至 1.04；P =.1）。肿瘤缺失的患者比非缺失的患者生存时间更长（PCV 联合 RT：14.7 年比 2.6 年，HR = 0.36，95%CI，0.23 至 0.57，P <.001；RT：7.3 年比 2.7 年，HR = 0.40，95%CI，0.27 至 0.60，P <.001），肿瘤缺失且接受 PCV 联合 RT 治疗的患者中位生存时间是接受 RT 治疗患者的两倍（14.7 年比 7.3 年；HR = 0.59；95%CI，0.37 至 0.95；P =.03）。对于非缺失肿瘤患者，治疗组的中位生存时间无差异（2.6 年比 2.7 年；HR = 0.85；95%CI，0.58 至 1.23；P =.39）。在包括缺失状态的 Cox 模型中，所有患者的 OS 均延长（HR = 0.67；95%CI，0.50 至 0.91；P =.01）。
对于 1p/19q 缺失的 AO/AOA 亚组患者，PCV 联合 RT 可能是一种特别有效的治疗方法，尽管这一观察结果来自于一项未计划的分析。
