LG Glioma. But maybe a little high grade.

[medgator]

Arguably the RTOG study was generous with their eligibility criteria with respect to who was considered high risk. So it remains unclear in the chemo era who >40 yo can be observed. Single institution data suggests benefit to earlier treatment but I think it remains unknown. Unplanned subset analyses of RTOG patients using genetic / molecular markers may give more insight into who most benefits chemo but still won't answer who to observe. A trial might answer this but with several years of cooperative group politics, CTEP hurdles and then 10 years of patient follow up we'll never really know.


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This was a paper I used in residency, haven't seen a LG one in quite awhile though

http://m.jco.ascopubs.org/content/20/8/2076.abstract

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[Damn_Daniel]

Was the same paper just quoted twice by the same person within the span of a week? Good god.

 

[radiaterMike]

Up until the recent RTOG study was published many used EORTC criteria to decide who had high vs. low risk disease and thus could be observed. But now if you have a patient who is 40+ or with STR everyone wants to treat on the best arm of the RCT in which that patient would have been eligible. We now know chemo+RT>RT. We don't know which group benefits from this (assuming all high risk patients as defined by RTOG don't benefit), whether upfront or delayed chemo+RT is better, what role adding concurrent Temodar has or if adjuvant Temodar can replace PCV.


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[Palex80]

I am not sure you can say "all patients benefit" from radiation + chemo.
MGMT negative patients with no 1p/19q codeletion probably gain very little -to nothing from chemo. I'd irradiate only in these patients.

 

[seper]

what data do you have to support that?? Again, we're talking LGG

 

[radiaterMike]

what data do you have to support that?? Again, we're talking LGG

Agree that we don't have data on who most benefits from chemo for LGG. Even with GBM Temodar is offered to most patients regardless of MGMT status (Stupp trial was not designed to answer that question). For LGG treated with PCV it may be that MGMT is not relevant.


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[Palex80]

what data do you have to support that?? Again, we're talking LGG

I was referring to anaplastic oligodendoglioma, sorry.

Early results from EORTC 22033 do however demonstrate that RT is better than chemo in patients with intact 1p. This could point out to the ineficcacy of chemo in not deleted patients. Maybe...