====== Oligodendroglioma treatment ======

Adults with newly diagnosed [[oligodendroglioma]], [[IDH mutant]], [[1p/19q co-deletion]] CNS [[WHO grade II]] and [[WHO grade III]] should be offered [[radiation therapy]] (RT) and [[procarbazine]], [[lomustine]], and [[vincristine]] (PCV). [[Temozolomide]] (TMZ) is a reasonable alternative for patients who may not tolerate [[PCV]], but no high-level evidence supports upfront TMZ in this setting.

The standard treatment for oligodendrogliomas is [[radiotherapy]] followed by [[procarbazine]], [[lomustine]], and [[vincristine]] [[chemotherapy]] if further treatment beyond surgery is considered necessary
((Buckner J.C., Shaw E.G., Pugh S.L., Chakravarti A., Gilbert M.R., Barger G.R., Coons S., Ricci P., Bullard D., Brown P.D., et al. Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma. N. Engl. J. Med. 2016;374:1344–1355. doi: 10.1056/NEJMoa1500925.))

The current treatment of oligodendroglioma made a major step forward when several papers showed prolonged survival in patients receiving radiotherapy and chemotherapy (RTC)
((Buckner J.C., Shaw E.G., Pugh S.L., Chakravarti A., Gilbert M.R., Barger G.R., Coons S., Ricci P., Bullard D., Brown P.D., et al. Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma. N. Engl. J. Med. 2016;374:1344–1355. doi: 10.1056/NEJMoa1500925.))
((Cairncross G., Wang M., Shaw E., Jenkins R., Brachman D., Buckner J., Fink K., Souhami L., Laperriere N., Curran W., et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: Long-term results of RTOG 9402. J. Clin. Oncol. 2013;31:337–343. doi: 10.1200/JCO.2012.43.2674.))
((Van den Bent M.J., Brandes A.A., Taphoorn M.J., Kros J.M., Kouwenhoven M.C., Delattre J.Y., Bernsen H.J., Frenay M., Tijssen C.C., Grisold W., et al. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: Long-term follow-up of EORTC brain tumor group study 26951. J. Clin. Oncol. 2013;31:344–350. doi: 10.1200/JCO.2012.43.2229.))
((Cairncross J.G., Wang M., Jenkins R.B., Shaw E.G., Giannini C., Brachman D.G., Buckner J.C., Fink K.L., Souhami L., Laperriere N.J., et al. Benefit from procarbazine, lomustine, and vincristine in oligodendroglial tumors is associated with mutation of IDH. J. Clin. Oncol. 2014;32:783–790. doi: 10.1200/JCO.2013.49.3726.)).


Surgery is the primary treatment for [[IDH mutant]] and [[1p/19q codeletion]] [[oligodendroglioma]].
Although contemporary trials addressing this issue are not available, watch-and-wait strategies are justified in patients with macroscopically complete resection, and also in younger patients (aged <40 years) with incomplete resection if the tumour has not already caused neurological deficits beyond symptomatic epilepsy
((Buckner J.C., Shaw E.G., Pugh S.L., Chakravarti A., Gilbert M.R., Barger G.R., Coons S., Ricci P., Bullard D., Brown P.D., et al. Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma. N. Engl. J. Med. 2016;374:1344–1355. doi: 10.1056/NEJMoa1500925.))
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The long-term results drawn from 20-years of single institution experience show that the patients with 1p/19q co-deleted oligodendrogliomas can be successfully treated with up-front chemotherapy alone without compromising OS
((Iwadate Y, Matsutani T, Hara A, Hirono S, Ikegami S, Kobayashi M, Ito D,
Kawauchi D, Horiguchi K, Tamiya A, Higuchi Y. Eighty percent survival rate at
15 years for 1p/19q co-deleted oligodendroglioma treated with upfront
chemotherapy irrespective of tumor grade. J Neurooncol. 2019 Jan;141(1):205-211. 
doi: 10.1007/s11060-018-03027-5. Epub 2018 Dec 18. PubMed PMID: 30565028.
)).

===== References =====