The use of chemotherapy in low-grade gliomas has been very thoroughly studied in the setting of oligodendrogliomas and oligoastrocytomas. According to the Radiation Oncology staff here at Thomas Jefferson University Hospital, the current practices in our institution are as follows: Three-dimensional conformal radiation is provided in patients with low-grade gliomas 2-4 weeks post-operatively. The total dose ranges between 50 and 54 Gy and is delivered in 1.8 fractions at five fractions per week. In the presence of recurrence, a stereotactic boost with or without re-operation is provided. For the most part, these practices are similar to the aforementioned recommendations. However, factors such as the age of the patient, and optimal timing of the radiation are not considered in our institution at this given time. Chemotherapy is restricted to patients with known pathology of oligodendroglioma. PCV is the chemotherapeutic agent of choice in both research recommendations and our clinical practice. Specifically, the use of PCV in an established oligodendroglioma case has shown to increase the time to progression and provide a statistically significant survival benefit. Furthermore, this response is augmented in patients with chromosomal analysis positive for the 1p and 19q allele mutation. For these patients, further chromosomal analysis is performed in order to predict the chemotherapy response rate. Recurrent disease is managed on a patient specific basis.
Tjoumakaris, Stavropoula MD
"Adjuvant Treatment in the Management of Low-Grade Gliomas,"
JHN Journal: Vol. 4
, Article 4.
Available at: http://jdc.jefferson.edu/jhnj/vol4/iss3/4