High Grade (III, Anaplastic) Gliomas

Question 1

Role of RT in anaplastic gliomas?

Answer 1

Walker (J NSY 1978), PRT
R best supportive care VS BCNU alone VS RT alone VS RT+BCNU.
50-60 Gy to whole brain!
MS 14 wks, 18.5 wks, 35 wks, & 35 wks.

Question 2

PCV + RT?

Answer 2

*neither study included anaplastic astrocytomas (RTOG 9813 only data, no diff OS btw RT/TMZ and RT/nitrosurea but worse toxicity with NU).
(1) Cairncross, RTOG 9402 (JCO 2006 & 2013), PRT
R 4c neoadjuvant PCV + RT vs RT alone
59.4Gy/33fx
Originally no diff in survival seen.
2014 subset analysis: IDH mutated tumors live longer with chemoRT, codel pts lived the longest.
IDHmut+codel, MS 14.7 yrs
IDHmut but 1p19q intact, MS 5.5 yrs
IDH WT MS 1.8 yrs

(2) van den Bent, EORTC 26951 (JCO 2006 & 2013), PRT
After surgery, Randomized RT+6c adj PCV vs RT alone.
59.4Gy/33fx
PCV group had better MS with no diff in QOL (42 vs 31 months).

Question 3

TMZ + RT?

Answer 3

(1) RTOG 0131, ph II, single arm
Similar MS and PFS as PCV studies.

(2) Wick, NOA-04 (JCO 2009 & 2016), PRT
Arm A RT alone 54-60 Gy, arm B1 RT/PCV, arm B2 RT/TMZ.
No diff PFS or OS.

(3) van den Bent, EORTC CATNON (Lancet 2017), PRT
1p19q intact patients, randomized after surgery
(A) RT alone (B) RT/conTMZ (C) RT/adjTMZ (D) RT w/concurrent & adjuvant TMZ.
59.4Gy/33fx
Adjuvant TMZ improved OS (HR 0.65).