Phase III Trial of Chemoradiotherapy for Anaplastic Oligodendroglioma: Long-Term Results of RTOG 9402
Phase III Trial of Chemoradiotherapy for Anaplastic Oligodendroglioma: Long-Term Results of RTOG 9402
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DOI：
10.1200/jco.2012.43.2674
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发表时间：
2013-01-20
影响因子：
45.3
通讯作者：
Mehta, Minesh
中科院分区：
文献类型：
--
作者：
Cairncross, Gregory;Wang, Meihua;Mehta, Minesh
目的间变性少突胶质细胞瘤，单纯(AO)和混合性(间变性少星形细胞瘤[AOA])是化疗敏感的，特别是如果联合治疗1p/19q，但患者在化疗和放射治疗后是否存活时间尚不清楚。结果291例符合条件的患者随机分为PCV+RT组148例和RT组143例。在整个队列中，经治疗的中位生存期没有差异(PCV加RT的中位生存期为4.6年，RT的中位生存期为4.7年；风险比[HR]=0.79；95%CI，0.60比1.04；P=.1)。共剔除肿瘤的患者比未共剔除肿瘤的患者存活时间更长(PCV+RT：14.7v2.6年，HR=0.36，95%CI，0.23~0.57，P<；0.001；RT：7.3v2.7年，HR=0.40，95%CI，0.27~0.60，P<；0.001.)，PCV+RT治疗的肿瘤患者的中位生存期是放疗患者的两倍(14.7v7.3年；HR=0.59；95%可信区间为0.37~0.95；P=.03)。对于那些非联合切除的肿瘤，治疗组的中位生存期没有差异(2.6v2.7年；HR=0.85；95%CI，0.58至1.23；P=0.39)。在包含共缺失状态的COX模型中，PCV+RT延长了所有患者的调整后OS(HR=0.67；95%CI，0.50至0.91；P=0.01)。结论对于1p/19q共同缺失的AO/AOA患者亚群，PCV+RT可能是一种特别有效的治疗方法，尽管这一观察来自一项计划外分析。J Clin Oncol31：337-343.(C)2012年美国临床肿瘤学会
PurposeAnaplastic 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.Patients and MethodsEligible 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).ResultsTwo 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).ConclusionFor 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. J Clin Oncol 31:337-343. (C) 2012 by American Society of Clinical Oncology