Outcomes for Anaplastic Glioma Treated With Radiation Therapy With or Without Concurrent Temozolomide. (August 2018)

• Record Type: Journal Article
• Authors: McTyre, Emory; Lucas, John T.; Helis, Corbin; Farris, Michael; Soike, Michael; Mott, Ryan; Laxton, Adrian W.; Tatter, Stephen B.; Lesser, Glenn J.; Strowd, Roy E.; Lo, Hui-Wen; Debinski, Waldemar; Chan, Michael D.
• Is Part Of: American journal of clinical oncology. Volume 41:Number 8(2018)
• Publication Date: 2018-08
• Subjects: anaplastic glioma -- grade III glioma -- anaplastic astrocytoma -- anaplastic oligodendroglioma; Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0000000000000380
• Languages: English
• ISSNs: 0277-3732

Abstract

Abstract : Objectives: Postoperative management of anaplastic glioma remains without a clear standard of care—in this study we report outcomes for patients treated with radiotherapy (RT) with and without temozolomide (TMZ). Materials and Methods: We identified 71 consecutive patients with World Health Organization grade III glioma treated with either RT alone or with concurrent TMZ (RT+TMZ), between 2000 and 2013. Tumor histology was anaplastic astrocytoma in 42 patients, anaplastic oligodendroglioma in 25 patients, and anaplastic oligoastrocytoma in 4 patients. In total, 26 patients received RT and 45 received RT+TMZ. Adjuvant TMZ was administered to 12/26 (46.1%) patients who received RT and 42/45 (93.3%) patients who received RT+TMZ. Time-to-event endpoints included progression-free survival (PFS) and overall survival (OS). Results: Kaplan-Meier estimates revealed that patients receiving RT+TMZ followed by adjuvant TMZ had improved PFS ( P =0.04) and OS ( P =0.02) as compared with those receiving RT followed by adjuvant TMZ. Cox proportional hazards multivariate analysis revealed improved PFS and OS with RT+TMZ for all patients (PFS: hazard ratio [HR]=0.42, P =0.02; OS: HR=0.41, P =0.03) and for anaplastic astrocytoma patients (PFS: HR=0.35, P =0.03; OS: HR=0.26, P =0.01), regardless of whether patients received further adjuvant TMZ. Conclusions: These findings support the use of RT+TMZ in the postoperative management of grade III glioma, and suggest that there is a benefit to concurrent RT+TMZ that is independent of adjuvant monthly TMZ. Further investigation is warranted, both to prospectively validate the benefit of RT+TMZ, as well as to determine if an additional benefit truly exists for adjuvant TMZ following concurrent RT+TMZ. Abstract : Supplemental Digital Content is available in the text.