title: Impact of 1p/19q codeletion and histology on outcomes of anaplastic gliomas treated with radiation therapy and temozolomide.
abstract: OBJECTIVE
  Anaplastic gliomas represent a heterogeneous group of primary high-grade brain tumors, and the optimal postoperative treatment remains controversial. In this report, we present our institutional data on the clinical outcomes of radiation therapy (RT) plus temozolomide (RT + TMZ) for anaplastic gliomas, stratified by histology and 1p/19q codeletion.
  
  
  METHODS
  A single-institution retrospective review was conducted of patients with supratentorial anaplastic oligodendroglioma (AO), mixed anaplastic oligoastrocytoma (AOA), and anaplastic astrocytoma (AA). After surgery, RT was delivered at a median total dose of 60 Gy (range, 31.6-63 Gy) in daily fractions. All patients received standard concurrent TMZ, with or without adjuvant TMZ. Histological/molecular subtypes were defined as codeleted AO/AOA, non-codeleted AO/AOA, and AA.
  
  
  RESULTS
  From 2000 to 2012, 111 cases met study criteria and were evaluable. Codeleted AO/AOA had superior overall survival (OS) to non-codeleted AO/AOA (91% vs 68% at 5 years, respectively, P=.02), whereas progression-free survival (PFS) was not significantly different (70% vs 46% at 5 years, respectively, P=.10). AA had inferior OS to non-codeleted AO/AOA (37% vs 68% at 5 years, respectively, P=.007) and inferior PFS (27% vs 46%, respectively, P=.03). On multivariate analysis, age, performance status, and histological or molecular subtype were independent predictors for both PFS and OS. Compared to historical controls, RT + TMZ provided comparable OS to RT with procarbazine, lomustine, and vincristine (RT + PCV) for codeleted AO/AOA, superior OS to RT alone for non-codeleted AO/AOA, and similar OS to RT alone for AA.
  
  
  CONCLUSIONS
  RT + TMZ may be a promising treatment for both codeleted and non-codeleted AO/AOA, but its role for AA remains unclear.
authors: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors: Christina K
authors: CK
authors: Speirs
authors: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors: Joseph R
authors: JR
authors: Simpson
authors: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors: Clifford G
authors: CG
authors: Robinson
authors: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors: Todd A
authors: TA
authors: DeWees
authors: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors: David D
authors: DD
authors: Tran
authors: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors: Gerry
authors: G
authors: Linette
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Michael R
authors: MR
authors: Chicoine
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Ralph G
authors: RG
authors: Dacey
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Keith M
authors: KM
authors: Rich
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Joshua L
authors: JL
authors: Dowling
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Eric C
authors: EC
authors: Leuthardt
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Gregory J
authors: GJ
authors: Zipfel
authors: Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Albert H
authors: AH
authors: Kim
authors: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: jhuang@radonc.wustl.edu.
authors: Jiayi
authors: J
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002872:Chromosome Deletion; D002878:Chromosomes, Human, Pair 1 / Q000235:genetics*; D002888:Chromosomes, Human, Pair 19 / Q000235:genetics*; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D017353:Gene Deletion; D020022:Genetic Predisposition to Disease / Q000453:epidemiology / Q000235:genetics; D005910:Glioma / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015995:Prevalence; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D000077204:Temozolomide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide