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.
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.
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DOI：
10.2147/ott.s115911
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发表时间：
2016
影响因子：
4
通讯作者：
Iihara K
中科院分区：
文献类型：
--
作者：
Hata N;Yoshimoto K;Hatae R;Kuga D;Akagi Y;Suzuki SO;Iwaki T;Shono T;Mizoguchi M;Iihara K
最近更新的III期临床试验显示，在放疗（RT）基础上加用丙卡巴肼-洛莫司汀-长春新碱化疗（CT）治疗伴有1 p19 q共缺失（codel）的间变性少突胶质细胞瘤具有良好效果。然而，这些肿瘤推迟RT和前期CT给药的潜在合理性尚待阐明。在这里，我们回顾性分析了我们的病例系列的长期结果与延迟RT和前期甲基苄肼+尼莫司汀+长春新碱（PAV）的引入管理治疗少突胶质细胞肿瘤。我们招募了36例在1999-2012年期间接受治疗的新诊断的少突胶质细胞肿瘤患者（17例，II级和19例，III级），并进行了中位69.0个月的随访。分析其临床和遗传预后因素，并评估无进展生存期、总生存期（OS）和无恶化生存期（DFS）。无论WHO分级如何，25例1 p19 q codel肿瘤患者最初从未接受过RT，其中23例接受了PAV治疗。1 p19 q codel肿瘤患者的75% OS为135.3个月（未达到中位OS），表明结局良好。多因素分析显示IDH突变和1 p19 q是独立的预后因素，而不是WHO分级;此外，IDH和1 p19 q状态将队列分为3组，具有显著不同的OS。DFS解释了II级和III级1 p19 q编码肿瘤患者的生存期延长而性能下降。1 p19 q codel少突胶质细胞瘤的延迟RT和前期PAV治疗与良好的结局相关，而不影响体能状态，无论WHO分级如何。
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.