Results in oligodendroglioma: postoperative radiotherapy combined with chemotherapy

The retrospective analysis of 39 cases of supratentorial oligodendroglioma included the years 1965 - 84. The 5-year and 10-year survival rates were 73.1% and 32.2%, respectively. Although oligodendrogliomas were benign tumor, the 10-year survival rate was not good. Recurrence of tumor appeared in 9 cases and some cases were noticed about 10 years after the treatment. So, long term follow-up is important for oligodendrogliomas. Our treatment for oligodendrogliomas was surgical removal and postoperative radiochemotherapy (radiation + ACNU + FT-207 + PSK) for several years. The previous cases who had only subtotal removal of tumor showed short survival time. On the other hand, the cases treated with postoperative radiotherapy or radiochemotherapy showed relatively good results.     

Treatment of oligodendrogliomas with or without postoperative irradiation

The authors have reviewed the treatment results in 42 patients with intracranial oligodendroglioma treated from 1940 through 1983 at the University of California, San Francisco. Two patients who died postoperatively were excluded from analysis. Eleven patients had mixed tumors, with a minor astrocytic component. The overall survival rates for the 29 patients with pure oligodendroglioma were 61% and 33% at 5 and 10 years, respectively; these rates for the 11 patients with mixed tumors were 57% and 38% at 5 and 10 years, respectively. The 10-year survival rate for 14 patients with pure oligodendroglioma who received greater than 45 Gy irradiation was 56% versus 18% for 11 patients who did not receive postoperative irradiation (p = 0.09). Nine patients with mixed tumor who received more than 45 Gy postoperatively had survival rates similar to those for the 14 patients with pure tumors irradiated with more than 45 Gy (p = 0.89). All patients who died of their tumor had evidence of intracranial recurrence. One patient, who did not receive initial postoperative irradiation, also had clinical and myelographic evidence of spinal seeding. All five patients examined postmortem had tumor recurrence at the primary site; one patient also had intraventricular seeding. Six of the 10 patients with pure oligodendroglioma who had a repeat biopsy at the time of tumor recurrence or at postmortem examination showed histological progression to an anaplastic astrocytoma or glioblastoma multiforme. Based on this study, adult patients with pure or mixed oligodendroglioma currently are treated with partial-brain irradiation to a dose of about 60 Gy. In general, children are treated with partial-brain irradiation to about 50 Gy.     

Analyses of IDH1 mutation and MGMT promoter methylation status for 5 cases of long-term survivors with glioblastoma

Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor with an extremely poor prognosis in spite of multimodal treatment approaches. The median survival time of patients with GBM is 15 months, and only 3-5% of patients survive longer than 36 months. Those patients who survive over 36 months after the initial diagnosis are defined as long-term survivors. In this study, we retrospectively performed clinical and molecular analyses of five long-term survivors of GBM (>36 months) and twenty four GBM patients with poor survival time as control group (<36 months) to identify any prognostic factors that potentially contribute to survival. The O⁶-methylguanine-DNA methyltransferase (MGMT) gene methylation status was evaluated by performing methylation specific polymerase chain reaction assays. The mutation of isocitrate dehydrogenase 1 and 2 were evaluated by the direct sequencing method. All five cases were primary GBMs and the coexistence of the oligodendroglioma component was checked for each case as GBM with oligodendroglioma component. All five cases showed MGMT promoter methylation (5/5). IDH1 mutation was detected in two of the long-term survivors with oligodendroglioma component (2/5) while no IDH1 mutation was detected in the control group. All patients were treated by gross total removal followed by radiotherapy and various chemotherapies including temozolomide. MGMT promoter methylation and IDH1 mutation might be favorable factors for long-term survival in GBM patients.     

Oligodendroglioma: incidence and biological behavior in a defined population

The cases of 208 patients with histologically confirmed oligodendrogliomas were studied. The incidence represents 4.2% of all primary brain tumors diagnosed in the Norwegian population over a 25-year period. All of these tumors were cerebral and the majority affected the frontal lobe. The patients' median age at diagnosis was 47 years, with a range from 3 to 76 years; 6% of the oligodendrogliomas occurred in children. The median duration of symptoms before diagnosis was 20.5 months (mean 43 months). Plain skull x-ray films showed calcified deposits in 28% of the tumors. At operation, most of the tumors were poorly defined, without cyst formation, hematoma necrosis, or calcification. The median duration of disease from onset of symptoms until death was 14 months in nine untreated cases. In surgically treated oligodendroglioma patients the median survival time from onset of symptoms was 74 months. The median postoperative survival time was 35 months (mean 52 months). Tumor calcification, as seen on plain skull x-ray films, was associated with a significantly longer survival period. The surgical findings of gross necrosis, gross hypervascularity, and soft tumor consistency were all related to a shorter total duration of disease. Grossly well demarcated lesions were associated with a significantly longer postoperative survival. The length of postoperative survival correlated with the preoperative clinical status. The cumulative proportion of patients surviving 5 years was 0.342. The patient's age and sex did not have a statistically significant influence on survival time. The extent of surgical excision only seemed to play a role when the neurosurgeon considered that he had removed the whole lesion: these patients had a median postoperative survival period 14 months longer than the other oligodendroglioma patients. The ABO blood group of the oligodendroglioma patient was of prognostic value. In particular, patients with blood group A had a distinctly poorer prognosis than patients with O or B blood. The survival data from this unselected series indicate that cerebral oligodendrogliomas have a less favorable prognosis than has generally been believed.     

Relative survival rates and patterns of diagnosis analyzed by time period for individuals with primary malignant brain tumor, 1973-1997

OBJECT: The purpose of this study was to examine patterns of diagnosis and relative survival rates in individuals in whom a primary malignant brain tumor was diagnosed between 1973 and 1997; follow-up review of these patients continued through the end of 1999. METHODS: The study population was composed of 21,493 patients with primary malignant brain tumors that were diagnosed between 1973 and 1997. Data on these patients were obtained from the population-based Surveillance, Epidemiology, and End Results Program. The study population was divided into three cohorts based on the year of diagnosis, and these groups were compared with respect to variables of interest by performing chi-square tests and relative survival analysis with the life table method. Over time, there were consistently more men, more Caucasians, more patients undergoing surgery, and more individuals 70 years and older who received the diagnosis of primary malignant brain tumor. An examination of proportions of individuals with astrocytoma, other; oligodendroglioma, other; and oligodendroglioma Grade III showed significant temporal changes with frontal and temporal lobe tumors occurring most often. The diagnosis was obtained at an earlier age in African-American than in Caucasian patients. Caucasians had higher proportions of glioblastoma multiforme (GBM), which was associated with decreased survival times, and of oligodendroglioma, other, whereas African Americans had higher proportions of astrocytoma, other; ependymoma Grade II or III; and medulloblastoma, all of which were associated with increased survival times. The relative survival case demonstrated a continuous improvement over time, although older patients, those who underwent biopsy only, and those with GBMs continue to have the poorest survival times. The relative survival rates of African Americans consistently were similar or worse than those of Caucasians when the groups were stratified by prognostic factors. CONCLUSIONS: Over time, the relative survival rate of individuals with primary malignant brain tumor has improved and differences in survival are seen by examining the race of the patients.     

The impact of genotype on outcome in oligodendroglioma: validation of the loss of chromosome arm 1p as an important factor in clinical decision making

OBJECT: Oligodendrogliomas are rare primary brain tumors. They comprise approximately 5 to 33% of all glial tumors but differ from astrocytomas by being associated with a more favorable prognosis, making their correct identification important. Allelic loss of chromosome arms 1p and 19q is found in a substantial subpopulation of tumors with an oligodendroglioma phenotype. Anaplastic oligodendrogliomas with allelic loss of 1p have been associated with chemosensitivity and a longer patient survival period. METHODS: Oligodendroglial neoplasms were studied using fluorescence in situ hybridization of formalin-fixed, paraffin-embedded tissue specimens; reference and target probe sets were used to map the telomeric regions of 1p and 19q. The results were correlated with the clinical characteristics of patients treated at our institution between 1993 and 2003. Data obtained in 96 patients were analyzed. This included 63 patients (65.6%) with World Health Organization (WHO) Grade II oligodendroglioma, 22 (23%) with Grade III oligodendroglioma, and 11 (11.4%) with mixed oligoastrocytoma. Analysis of 1p in patients with pure oligodendroglioma revealed a loss of 1p in 42 patients (49.4%). In 46 of these patients 19q was lost and in 70 (82.3%) there was concordance for combined loss or retention of both 1p and 19q (p < 0.0001). Patients with oligodendroglioma in whom a loss of 1p was present fared significantly better, and this outcome was unrelated to the treatment modality or WHO grade, compared with patients in whom 1p was intact (p < 0.05). CONCLUSIONS: To the authors' knowledge, this study includes the largest published series of WHO Grade II oligodendroglioma and 1p analysis. The results suggest that the association between long-term survival and 1p loss in oligodendroglioma is unrelated to treatment. The authors of further prospective studies may better determine the true value of the allelic loss of 1p and its implication for clinical decision making.     

Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma

A retrospective analysis is presented of factors affecting the length of survival of 285 consecutive adults with newly diagnosed biopsy-proven supratentorial anaplastic glioma (188 cases of glioblastoma multiforme, 76 of anaplastic astrocytoma, 11 of anaplastic mixed glioma, and 10 of anaplastic oligodendroglioma) treated at a regional cancer center from July, 1982, through December, 1987. The approach to initial therapy included maximum feasible resection and radiotherapy. The median survival time for all patients was 35 weeks. Multivariate analysis demonstrated that age, duration of symptoms, preirradiation performance status, tumor histology, accessibility to resection, extent of resection, radiotherapy, and prior low-grade glioma were significant independent variables influencing survival. The prognostic importance of age, duration of symptoms, performance status, and tumor histology are already recognized, but three "new" findings are reported. First, patients with anaplastic oligodendroglioma had the longest median survival time (278 weeks). Second, corrected for accessibility and all other variables, patients with gross total resection lived longer than those with partial resection, and patients with any degree of resection lived longer than those who underwent only a biopsy procedure. Third, patients with anaplastic glioma in whom there was a prior history of low-grade glioma lived significantly longer after the diagnosis of anaplastic glioma than did patients in whom the anaplastic glioma apparently arose de novo.     

Infratentorial oligodendroglioma: report of a case

Oligodendroglioma occurs primarily in the cerebral hemisphere in adult. A rare case of oligodendroglioma in the cerebellum is presented, and previous reported cases were reviewed. A thirty-one year old female was admitted to our service only with headache. CT scan demonstrated a low density mass in the vermis of the cerebellum which was not enhanced. Bilateral vertebral angiography showed an avascular mass in the vermis. The preoperative diagnosis was astrocytoma or ependymoma, and a suboccipital craniotomy was performed. The tumor which was soft, yellowish gray and well-circumscribed, was developed from the vermis and extended into the cisterna magna. The tumor which size was approximately 3 X 4 X 5 cm. Microscopically the specimen showed round, darkly stained nuclei and clear perinuclear cytoplasmic halos. Moreover, the immunoperoxidase method testified the absence of glial fibrillary acidic protein in the tumor cells. The pathological diagnosis was oligodendroglioma. Post-operatively the patient was doing well without any complications. There was no clinical nor CT evidence of tumor recurrence forty months after resection. The 11 reported cases of infratentorial oligodendroglioma including ours were analyzed and the following conclusion was obtained. Infratentorial oligodendroglioma occurs in the younger age group. The tumor has special tendency to form cyst. Frequency of calcification is low. Prognosis is good if the tumor is resected in early stage. Pre-operatively, however, it was difficult to differentiate oligodendroglioma from astrocytoma.     

Clinical and radiological prognostic factors of anaplastic oligodendroglioma treated by combined therapy

The clinical and radiological prognostic factors were investigated in 32 patients with newly diagnosed anaplastic oligodendroglioma treated by combined therapy using surgery, postoperative radiation therapy, and adjuvant chemotherapy between September 1994 and December 2002. Surgery aimed at total removal was followed by radiotherapy, and 3 weeks later by adjuvant chemotherapy repeated at 6- to 7-week intervals. Survival analysis showed that younger age, absence of preoperative headache, good postoperative Karnofsky Performance Status (KPS) score (>or=80), and relatively small tumor volume (<50 cm3) were predictors for longer survival in univariate analysis (p<0.05). Age and good postoperative KPS score were independent prognostic factors in multivariate analysis (p<0.05). Median survival was 58 months after diagnosis, and the 5-year survival rate was 49%.     

Spinal dissemination following operation on cerebral oligodendroglioma

Summary This paper concerns two cases of cerebral oligodendroglioma (intraventricular in one case, right temporal in the other), with spinal dissemination (cervical and upper thoracic respectively), manifested clinically 2 years and 14 months respectively after removal of the cerebral tumour. Anatomical examination confirmed the diagnosis of disseminated oligodendroglioma in the leptomeninges in both cases and also in the parenchyma in the second case.     

Metastatic oligodendrogliomas: a review of the literature and case report

Summary  Oligodendroglioma cells are detectable in the cerebro-spinal fluid in up to 14% of patients [10] and cerebellar and/or spinal cord involvement is a well known phenomenon [3]. Distant spread of oligodendroglioma is exceptional, probably due to the presence of the blood-brain barrier, the absence of lymphatic vessels and the short survival of patients. A review of the worldwide literature yielded 32 previously reported examples since 1951 to the present (Tab1e 1). This review was performed using NCBI-PubMed and “oligodendroglioma, oligodendrogliomas, metastatic, metastasis, metastases, extraneural”, in different combinations, as key words and reviewing the bibliography of the consequent selected articles. New therapeutic approaches are prolonging the overall survival of patients with primitive brain tumours and in particular of those with high grade oligodendroglioma which is a chemo-sensitive disease. A longer overall survival could increase the risk of extracranial dissemination of gliomas that in the future might become a less rare clinical complication. Correspondence: Fable Zustovich, Oncologia Medica 1, Istituto Oncologico Veneto, I.R.C.C.S, Padova, Italy; Ospedale Busonera, Via Gattamelata 64, 35128 Padova, Italy.     

少枝胶质细胞瘤中MMPs和TIMPs的表达及其意义

目的:探讨少枝胶质细胞瘤中基质金属蛋白酶(MMPs)及其组织抑制物(TI MPs)的表达,并分析其在肿瘤细胞间变中的作用。方法:用免疫组化方法检测少枝胶质细胞瘤标本中MMP-1、MMP-2、MMP-3、MMP-7、MMP-9、MMP-14和TI MP-1、TI MP-2的表达。结果:12例少枝胶质细胞瘤中,均存在MMP-1、MMP-2和MMP-14表达,MMP-1位于部分细胞核,MMP2位于胞核和胞浆,MMP-14位于胞膜和胞间基质;7例胞浆出现MMP-7弱阳性,仅个别存在MMP-3、MMP-9和TI MP-1、TI MP-2表达;MMP-1在非间变型和间变型之间,MMP-1和MMP-7在间变细胞和非间变细胞之间存在显著差异。结论:在少枝胶质细胞瘤中,存在MMPs的表达和TI MPs的缺乏,一些MMPs成员在非间变细胞和间变细胞之间存在一定的差异,MMPs的表达和TI MPs的缺乏可能参与了少枝胶质细胞瘤的发生、侵袭性生长和瘤细胞的间变。     

Leptomeningeal dissemination of a pediatric neoplasm with 1p19q deletion showing mixed immunohistochemical features of an oligodendroglioma and neurocytoma

Leptomeningeal dissemination of an oligodendroglioma is rarely reported in the neurosurgical literature, especially in cases with a classical 1p19q deletion. The authors describe a case wherein a 1p19q deletion in a disseminated tumor with mixed immunohistochemical features of oligodendroglioma and neurocytoma was encountered and treated. Stereotactic right frontal craniotomy was undertaken for obtaining definitive histological diagnosis. The results revealed a neuroectodermal neoplasm with histologic and immunohistochemical features of oligodendroglioma and neurocytoma. FISH analysis confirmed classical 1p19q deletion. The patient was treated postoperatively with chemotherapy and radiation therapy. He showed good clinical response and remains alive 16 months after diagnosis.     

Multifocal brain radionecrosis masquerading as tumor dissemination

The authors report on an autopsy-proven case of multifocal widespread radionecrosis involving both cerebral hemispheres and masquerading as tumor dissemination on a CT scan done 13 months after complete resection of an oligodendroglioma followed by radiation therapy. This case demonstrates that radiation damage may be present in a CT scan as a multifocal, disseminated lesion. Since the survival of brain-tumor patients who have undergone radiation therapy is prolonged by aggressive therapy, the incidence and variability of radiation-induced complications in such cases is likely to increase. For similar reasons, the radionecrosis in such cases should be taken into consideration. A short review of the CT scan findings and diagnostic and therapeutic considerations in a case of widespread radionecrosis is presented. The need for appropriate diagnosis and subsequent life-saving management is emphasized.     

Clinicopathological study of oligodendroglioma with special reference to immunohistochemical investigation

The present study was undertaken to evaluate the utility of pathologic features and specific immunohistochemical studies in estimating the prognosis of oligodendroglioma. The pathological diagnosis of an oligodendroglioma was made on HE stained-sections according to WHO classification. Sixteen oligodendrogliomas, twelve mixed oligoastrocytomas and ten anaplastic oligodendrogliomas were immunotested by the peroxidase-antiperoxidase (PAP) method with anti-GFAP serum, anti-S-100 serum and anti-MBP (Myelin basic protein) serum and by the avidin biotin peroxidase-complex (ABC) method with anti-vimentin serum and ant-Leu 7 monoclonal antibody. GFAP positive cells were interpreted as reactive astrocytes, neoplastic astrocytes and neoplastic oligodendrocytes, S-100 positive cells were interpreted as reactive astrocytes and neoplastic astrocytes. Leu 7 positive cells were found in only one case of anaplastic oligodendroglioma. Anti-Leu 7 could not be considered as a specific marker for oligodendroglioma. Of the anaplastic oligodendroglioma 60% displayed MBP positively and 70% displayed vimentin positively. NSE positive cells were found in a few anaplastic oligodendrogliomas. The present study has not so far uncovered any marker that is restricted to oligodendrogliomas. However GFAP may be useful to assess the extent of reactive astrocytes and neoplastic astrocytes in the oligodendroglioma or mixed oligoastrocytoma. MBP and vimentin will help to determine the malignancy of oligodendroglioma.     

Oligodendroglial proliferative abnormality associated with arteriovenous malformation: report of three cases with review of the literature

A peculiar nonneoplastic oligodendroglial proliferative abnormality associated with cerebral arteriovenous malformations (AVMs) was present in three patients. Histological examination of biopsy material revealed dense oligodendroglial tissue reminiscent of oligodendroglioma in the white matter adjoining the AVMs. Careful consideration of clinical and pathological features suggested that the evidence was insufficient to qualify the lesion as truly neoplastic (oligodendroglioma); rather, a tissue collapse or a hamartomatous proliferation could be considered to be its cause. The literature contains 14 instances of various vascular malformations associated with primary brain tumors, 5 of which were diagnosed as oligodendrogliomas. It is possible, however, that some of the cases reported in the literature constitute oligodendroglial abnormality similar to that observed in our cases rather than genuine oligodendrogliomas. Attention is drawn to this interesting and prognostically important phenomenon.     

Prognostic significance of the endothelial surface in low-grade resected oligodendrogliomas

The importance of angiogenesis as a prognostic factor in brain tumours has recently been reported. In this study, we analysed the long-term prognostic significance of a morphometric score expressing the endothelial area for every 1000 tumour cells, in tumour tissue from 26 patients with a low-grade oligodendroglioma that has been treated surgically and irradiated, and has a MIB-1 labelling index (MIB-1 LI) of less than 1%. In each tumour, a vascular endothelial surface index (VESI) was determined as the CD-34 immunostained endothelial area in micron 2 per 1000 tumour cells. Patients with a VESI of less than 15 (n = 12) showed a survival at 5 and 10 years of 100 and 71%, respectively, versus a survival of 50 and 0% for patients presenting a VESI greater than 15 (n = 14); p < 0.05). Our present findings suggest the usefulness of VESI as a long-term prognostic pathological factor in low-grade oligodendroglioma.     

Extracranial metastases of anaplastic cerebral gliomas

Summary Seven cases are reported of anaplastic cerebral gliomas with metastases outside the neuraxis, seen among about 1500 gliomas. There were two children with anaplastic ependymomas, one adult with oligodendroglioma, and four young to middle-aged adults with astrocytomas grade III and IV. All patients had one or more craniotomies, and four had radiotherapy prior to the appearance of distant tumour deposits. The survival times ranged from 7 to 31 months in cases with gliomas grade II, and from 8 to 18 months with high grade astrocytomas. All seven tumours showed invasion of the meninges, ventricular walls, or both, and in four cases they transgressed the dura and surrounding bone or soft tissues. In six autopsy cases there was widespread dissemination of gliomas through the CSF pathways. Distant metastases involved regional or distant lymph nodes in six patients, the lungs in two, and the vertebrae, pleura, liver, or mediastinum in one patient each. The possible pathways for distant spread of intracranial gliomas and the factors which are considered responsible are briefly discussed.     

Impact of extent of resection and adjuvant therapy in diffuse gliomas of the spine

BACKGROUND CONTENTDiffuse gliomas of the spine (DGS)—consisting of intradural intramedullary glioblastoma, astrocytoma, and oligodendroglioma—are exceedingly rare tumors that account for about 2% of primary spinal cord tumors. Much is unknown about their optimal treatment regimen due to a relative lack of clinical outcome data.PURPOSETo provide an updated analysis on treatment and outcomes in DGS.STUDY DESIGN/SETTINGObservational cohort study using The National Cancer Database (NCDB), a multicenter prospectively collected oncology outcomes database. A systematic literature review was also performed to compare the resulting data to previous series.PATIENT SAMPLEPatients with histologically confirmed DGS from 2004 to 2018.OUTCOME MEASURESLong-term overall survival and short-term 30/90-day postsurgical mortality, 30-day readmission, and prolonged hospital length of stay.METHODSImpact of extent of resection and adjuvant therapy on overall survival was evaluated using Kaplan–Meier estimates and multivariable Cox proportional hazards regression. Univariate and multivariate logistic regression was used to analyze covariables and their prognostic impact on short-term surgical outcomes.RESULTSOf the 747 cases that met inclusion criteria, there were 439 astrocytomas, 14 oligodendrogliomas, and 208 glioblastomas. Sixty percent (n=442) of patients received radiation, and 45% (n=324) received chemotherapy. Tumor histology significantly impacted survival; glioblastoma had the poorest survival (median survival time [MS]: 12.3 months), followed by astrocytoma (MS: 70.8 months) and oligodendroglioma (MS: 71.6 months) (p<.001). Gross total resection (GTR) independently conferred a survival benefit in patients with glioblastoma (hazard ratio [HR]: 0.194, p<0.001) and other WHO grade four tumors (HR: 0.223, p=.003). Adjuvant chemotherapy also improved survival in patients with glioblastoma (HR: 0.244, p=.007) and WHO grade four tumors (HR: 0.252, p<.001). Systematic literature review identified 14 prior studies with a combined DGS mortality rate of 1.3%, which is lower than the 4% real-world outcomes calculated from the NCDB. This difference may be explained by selection biases in previously published literature in which only centers with favorable outcomes publish their results.CONCLUSIONSThere remains a paucity of data regarding treatment paradigms and outcomes for DGS. Our analysis, the largest to date, demonstrates that GTR and adjuvant therapy independently improve survival for certain high-grade subgroups of DGS. This best-available data informs optimal management for such patients.     

Prognostic factors in oligodendrogliomas

Summary An outcome analysis was performed on 96 patients with pure cerebral oligodendrogliomas operated in the 30-year period 1962 to 1991.The most important predictive prognostic factors were youth and no neurological deficit, demonstrated as a median survival for the group younger than 20 years of 17.5 years and for the group older than 60 years of 13 months. The group without neurological deficits had a 5-years survival of 43 per cent while the group with deficits had a 5-years survival of 5 per cent.The 5-years survival for oligodendroglioma of grade II was 46 per cent and for grade III 10 per cent.We found no effect of radiotherapy on survival, neither in the whole material or in any subgroup.