The Current Treatment Approach for Anaplastic Gliomas - Abstract
Grade 3 gliomas include 6–10 % of all newly diagnoses of primary brain tumors and comprise 6–15% of all primary brain tumors. Three histological subtypes are characterized: anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA). During the past decade, understanding of molecular and prognostic significance of genetic alterations in anaplastic gliomas (AG) has changed treatment strategies of these tumors, particularly for oligodendroglial subtype. The initial treatment for AG is maximal safe resection. The management after initial surgery of AG with 1p/19q codeletion includes radiotherapy (RT) and PCV (procarbazine, CCNU, vincristine) chemotherapy as established by EORTC 29651 and RTOG 9402 trials. The sequence of RT and chemotherapy has not been defined; therefore both neoadjuvant and adjuvant chemotherapy may be applied. The second treatment option is RT plus Temozolomide chemotherapy for 1p19q co-deleted tumors. The treatment of uni- or nondeleted AG is either RT only or primary alkylator-based chemotherapy only with deferred RT as determined in NOA-04. The combined therapy with radiation plus Temozolomide in patients with newly diagnosed AA patients is an alternative treatment option. We should await mature results from CATNON study to help determine whether use of concurrent Temozolomide during radiation, in addition to 12 cycles of adjuvant Temozolomide, provides increased benefit. There has been no standard therapy for patients with recurrent AG. At progression, the option of second surgery should be explored. Alkylating chemotherapy is the treatment of choice for most patients previously untreated with chemotherapy. Re-irradiation is another option for recurrent AG.