Influence of an oligodendroglial component on the survival of patients with anaplastic astrocytomas: A report of radiation therapy oncology group 83-02 |
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| Authors: | Bernadine Donahue MD Charles B Scott PhD James S Nelson MD Marvin Rotman MD Kevin J Murray MD Diana F Nelson MD Franklin L Banker MD John D Earle MD Jennifer A Fischbach MD Sucha O Asbell MD Laurie E Gaspar MD Arnold M Markoe MD Walter Curran MD |
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| Institution: | ?New York University Medical Center, New York, NY, USA;?American College of Radiology, Philadelphia, PA, USA;?Louisiana State University Medical Center, New Orleans, LA, USA;§SUNY Brooklyn, Brooklyn, NY, USA;∥Medical College of Wisconsin, Milwaukee, WI, USA;¶University of Rochester Cancer Center, Rochester, NY, USA;#Radiological Associates of Sacramento Medical Group, Sacramento, CA, USA;??Mayo Clinic, Rochester, MN, USA;??Latter Day Saints Hospital, Salt Lake City, UT, USA;??Albert Einstein Medical Center, Philadelphia, PA, USA;§§Wayne State University, Detroit, MI, USA;∥∥University of Miami, Miami, FL, USA;¶¶Thomas Jefferson University Hospital, Philadelphia, PA, USA |
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| Abstract: | 
: Seven percent of patients with high grade gliomas enrolled in RTOG 83-02 had mixed astrocytoma/oligodenroglial elements on central pathology review. It has often been assumed that the most aggressive histologic component of a tumor determines biologic behavior; however in this trial, the survival of patients who had mixed glioblastomas/oligodenrogliomas was significantly longer than that of patients with pure glioblastomas (GBM). We therefore evaluated the effect of an oligodendroglial component on the survival of patients who had anaplastic astrocytomas (AAF) treated in the same trial.
: One hundred nine patients who had AAF and 24 patients with mixed AAF/oligodendrogliomas (AAF/OL) were enrolled in a Phase I/II trial of randomized dose-escalation hyperfractioned radiotherapy plus BCNU. AAF/OL patients were older and more likely to have had more aggressive surgery than AAF patients. Other pretreatment characteristics were balanced between groups, as was assigned treatment.
: The median survival time for AAF was 3.0 years versus 7.3 years for AAF/OL (p = 0.019). In a multivariate analysis, adjusting for extent of surgical resection and age, an oligodendroglial component was an independent prognostic factor for survival.
: The results support the concept that AAFs with an oligodendroglial component have a better prognosis than pure AAF tumors, similar to the effect seen among patients with glioblastoma multiforme tumors. This better survival outcome should be taken into consideration in the design and stratification of future trials. Additionally, in contrast to patients with GBMs, patients who have AAF/OL have the potential for prolonged survival; therefore, late sequelae of treatment (both radiation and chemotherapy) must be weighed more heavily in the benefits to risks analysis.
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| Keywords: | Anaplastic astrocytoma Oligodendroglioma Hyperfractionation |
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