Oligodendroglioma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]Sujit Routray, M.D. [3]

The predominant therapy for oligodendroglioma is surgical resection. Adjunctive chemotherapy and radiation are required. Supportive therapy for oligodendroglioma includes anticonvulsants and corticosteroids.

Innovative treatment options:

• Brain tumors can be complex and require a combination of treatments for the best outcome.
• There is quite a wide range of treatments to meet the individual needs of each patient which includes standard therapies, precision medicine and clinical trials.
• Some of them are listed below:
  • Brachytherapy:
    • Destroys tumors by implanting radioactive medicine directly to or near the treatment site.
  • Chemotherapy:
    • Reaches cancer that may have spread, even microscopically, throughout the body.
  • Craniotomy:
    • Surgical procedure that removes a bone flap, a section of the skull, to access the brain.
  • Intensity-modulated radiation therapy:
    • Uses computer technology to deliver radiation treatment that precisely fits the size and shape of the tumor.
  • Minimally invasive cranial base surgery:
    • Uses smaller incisions and specially designed instruments to eliminate a tumor while saving the surrounding tissue from damage.
  • Stereotactic radiosurgery & radiotherapy:
    • A noninvasive procedure that applies large doses of radiation directly to a tumor.

The medical therapy for oligodendroglioma includes:

• Post-operative radiotherapy is recommended among all patients who develop oligodendroglioma.^[1][2]
• Radiotherapy may not cure the cancer but it can:
  • Control the tumor
  • Delay recurrence
  • Increase survival
• External beam radiation therapy is preferred to whole brain radiotherapy.^[1]
• External beam radiation therapy is usually administered in standard fractions of 1.8–2 Gy and can reach a total dose of 60 Gy.^[3]

• Chemotherapy is indicated as adjuvant therapy for oligodendroglioma.^{[1][4][5][6][7]}
• Oligodendroglioma responds better to chemotherapy than astrocytoma of comparable grade.^[8]
• Oligodendroglioma is the most chemosensitive of all the glial tumors.^[9]
• Symptomatic, aggressive, enlarging, enhancing, and non-anaplastic oligodendrogliomas respond better to chemotherapy.^[10]
• Temozolomide (Temodar) is the preferred drug for the treatment of oligodendroglioma.^[1]
• PCV 3 regimen is the preferred combination chemotherapy for anaplastic oligodendroglioma which includes the following dosing schedule:^[1][11]
  • CCNU is administered on day 1
  • Procarbazine is administered daily for 14 days beginning on day 8
  • Vincristine is administered on days 8 and 29 of each 6-week cycle of therapy^[12]
• Other chemotherapeutic drugs that may be used for the treatment of oligodendroglioma include:^[13][9]
  • Carmustine
  • Cisplatin
  • Erlotinib
  • Hydroxyurea
  • 6-thioguanine
  • Irinotecan
  • Methotrexate (intrathecally)
  • Diaziquone
• If oligodendroglioma is unresponsive to the chemotherapeutic drugs used in earlier treatments or if it recurs, other drugs that may be used include:^[13]
  • Tamoxifen
  • Carboplatin
  • Etoposide

• Supportive therapy for oligodendroglioma focuses on relieving symptoms and improving the patient’s neurologic function and includes:^[1]
• Anticonvulsants:
  • Anticonvulsants are administered to the patients who have a seizure
  • Phenytoin given concurrently with radiation may have serious skin reactions such as:
    • Erythema multiforme
    • Stevens-Johnson syndrome
• Corticosteroids:
  • Usually dexamethasone is given 4-10 mg every 4-6 h, which leads to:
    • Reduced peritumoral edema
    • Diminished mass effect
    • Lower intracranial pressure with a decrease in symptoms (headache or drowsiness)

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