title: Deferred radiotherapy and upfront procarbazine-ACNU-vincristine administration for 1p19q codeleted oligodendroglial tumors are associated with favorable outcome without compromising patient performance, regardless of WHO grade.
abstract: Recently updated phase III trials revealed the favorable effect of add-on procarbazine-lomustine-vincristine chemotherapy (CT) to radiotherapy (RT) in treating anaplastic oligodendrogliomas with 1p19q codeletion (codel). However, the underlying rationality of deferring RT and upfront CT administration for these tumors is yet to be elucidated. Here, we retrospectively analyzed the long-term outcome of our case series with oligodendroglial tumors treated with deferred RT and upfront procarbazine+nimustine+vincristine (PAV) in the introduction administration. We enrolled 36 patients with newly diagnosed oligodendroglial tumors (17, grade II and 19, grade III) treated during 1999-2012 and followed up for a median period of 69.0 months. Their clinical and genetic prognostic factors were analyzed, and progression-free survival, overall survival (OS), and deterioration-free survival (DFS) were evaluated. Regardless of the WHO grade, the 25 patients with 1p19q codel tumors never received RT initially, and of these 25, 23 received PAV treatment upfront. The 75% OS of patients with 1p19q codel tumor was 135.3 months (did not reach the median OS), indicating a favorable outcome. Multivariate analysis revealed thatIDHmutation and 1p19q, not WHO grade, are independent prognostic factors; furthermore,IDHand 1p19q status stratified the cohort into 3 groups with significantly different OS. The DFS explained the prolonged survival without declining performance in patients with both grade II and III 1p19q codel tumors. Deferred RT and upfront PAV treatment for 1p19q codel oligodendrogliomas were associated with favorable outcomes without compromising performance status, regardless of WHO grade.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University; Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hata
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimoto
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Hatae
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kuga
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Akagi
authors.affiliation: Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Satoshi O
authors.initials: SO
authors.lastname: Suzuki
authors.affiliation: Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Toru
authors.initials: T
authors.lastname: Iwaki
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University; Department of Neurosurgery, Harasanshin Hospital, Fukuoka.
authors.forename: Tadahisa
authors.initials: T
authors.lastname: Shono
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University; Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mizoguchi
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
keywords: 1p19q codel; IDH; PAV; oligodendroglioma