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PCV for Oligodendroglial Tumors: In Search of Prognostic Factors for Response and Survival

Published online by Cambridge University Press:  02 December 2014

David Fortin ,
David. R. Macdonald ,
J. Gregory Cairncross  and
Larry Stitt
David Fortin
Affiliation:
Departments of Neurosurgery and Neuro-oncology, Centre Universitaire de Santé de l’Estrie, Sherbrooke University, Sherbrooke, London, ON Canada
David. R. Macdonald
Affiliation:
Departments of Oncology, and Clinical Neurological Sciences, University of Western Ontario, London, ON Canada
J. Gregory Cairncross
Affiliation:
Departments of Oncology, and Clinical Neurological Sciences, University of Western Ontario, London, ON Canada
Larry Stitt
Affiliation:
Department of Biometry and Outcome Measurement, London Regional Cancer, Center, London, ON Canada
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Abstract

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Background:

We report survival and pretreatment prognostic factors for survival and chemosensitivity in 53 oligodendrogliomas treated with PCV (procarbazine, lomustine and vincristine) chemotherapy.

Methods:

A total of 53 patients with histologically proven oligodendroglioma, anaplastic oligodendroglioma or oligo-astrocytoma and treated with PCVwere extracted from the London Regional Cancer Center database. A retrospective review was conducted to evaluate overall survival and pretreatment prognostic factors for survival and chemosensitivity.

Results:

The median survival time from diagnosis was 123.6 months. The overall five- and ten-year survival rates were 72.7% and 52.7% respectively. Age <40, seizure as an initial symptom, absence of cognitive deficit and presence of a homogeneous hypodense lesion without contrast enhancement on the initial pretreatment CT scan were all factors independently associated with favorable outcome. The presence of increased cellularity, pleomorphism, mitosis, vascular proliferation and grading as an anaplastic lesion using these surrogates on pathological assessment, were all associated with an unfavorable outcome in univariable analysis. In multivariable analysis, only the anaplastic grading and presence of increased cellularity were significant determinants of unfavorable survival. The only factor adversely associated with chemosensitivity was the presence of a focal symptom at presentation.

Conclusion:

Overall survival is significantly longer in oligodendroglial lesions than in fibrillary astrocytic tumors. A two tier grading system using standard morphological features seems accurate in predicting outcome in these patients. The presence of a neoplastic astrocytic component does not seem to impact the outcome. No clinical, radiological or pathological factor could be identified to reliably predict chemotherapy response.

Résumé:

RÉSUMÉ:Introduction:

Nous rapportons des données sur la survie et les facteurs pronostiques de survie et de chimiosensibilité avant traitement chez 53 patients porteurs d'oligodendrogliomes traités par chimiothérapie au PCV (procarbazine, lomustine et vincristine).

Méthodes:

53 patients porteurs d'un oligodendrogliome prouvé par anatomopathologie, un oligodendrogliome anaplasique ou un oligo-astrocytome et traités au PCVont été identifiés dans le registre du London Regional Cancer Center. Une revue rétrospective a été effectuée pour évaluer la survie générale et les facteurs pronostiques de survie et de chimiosensibilité avant traitement.

Résultats:

La survie médiane à partir du moment du diagnostic était de 123.6 mois. Le taux de survie général après 5 et 10 ans était de 72.7% et 52.7% respectivement. Un âge inférieur à 40 ans, une crise convulsive comme symptôme initial, l'absence de déficit cognitif et la présence d'une lésion hypodense homogène sans rehaussement du contraste au CTscan initial avant traitement étaient tous des facteurs associés de façon indépendante à un bon pronostic. La présence d'une cellularité accrue, de pléomorphisme, de mitoses, de prolifération vasculaire et le fait que la lésion soit classifiée comme anaplasique au moyen de ces marqueurs à l'examen anatomopathologique ont tous été associés à un pronostic défavorable à l'analyse univariée. À l'analyse multivariée, seule la classification de la lésion comme étant anaplasique et la présence d'une cellularité accrue étaient des déterminants significatifs d'une survie défavorable. Le seul facteur associé négativement à la chimiosensibilité était la présence d'un symptôme focal comme mode de présentation.

Conclusion:

La survie générale est significativement plus longue chez les patients atteints de lésions oligodendrogliales que chez ceux qui ont des tumeurs astrocytaires fibrillaires. Un système de classification à deux niveaux basé sur les caractéristiques morphologiques standards semble fournir un pronostic précis chez ces patients. La présence d'une composante astrocytaire néoplasique ne semble pas influencer le pronostic. Aucun facteur clinique, radiologique ou anatomopathologique prédisant la réponse à la chimiothérapie n'a pu être identifié.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Issue 3 , August 2001 , pp. 215 - 223
Copyright
Copyright © The Canadian Journal of Neurological 2001

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