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Sequencing of Chemotherapy and Radiotherapy for Newly Diagnosed Anaplastic Oligodendroglioma and Oligoastrocytoma

Ryckman, Jeffrey M., MD*; Surkar, Swati M., PhD; Haque, Waqar, MD; Butler, E. Brian, MD; Teh, Bin S., MD; Verma, Vivek, MD§

American Journal of Clinical Oncology: March 2019 - Volume 42 - Issue 3 - p 258–264
doi: 10.1097/COC.0000000000000511
Original Articles: Central Nervous System

Introduction: Adjuvant management of anaplastic oligodendrogliomas (AOs) and anaplastic oligoastrocytomas (AOAs) is guided by 2 seminal phase III trials, one of which utilized radiotherapy (RT) followed by chemotherapy (CT) (RT-CT), and the other in which CT was followed by RT (CT-RT). Both paradigms are endorsed by the National Comprehensive Cancer Network because no direct comparison in the first-line (nonprogressive) setting has been performed to date. This study of a contemporary national database sought to evaluate practice patterns and outcomes between both approaches.

Materials and Methods: The National Cancer Database (NCDB) was queried for newly diagnosed AO/AOA treated with postoperative sequential CT-RT or RT-CT. Multivariable logistic regression ascertained factors independently associated with delivery of a particular paradigm. Overall survival (OS) between cohorts was compared using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazards modeling evaluated factors associated with OS.

Results: Of 225 patients, 19 (8.4%) received CT-RT and 206 (91.6%) underwent RT-CT. Groups were well-balanced, although CT-RT was more often administered to men (P=0.009) and AOs (P=0.037). Median follow-up was 58 months. Median OS in the CT-RT cohort was 93 months (95% confidence interval, 37-150 mo), and 107 months (95% confidence interval, 72-142 mo) in the RT-CT group (P=0.709). Therapy sequence was not associated with OS on univariate (P=0.709) or multivariate (P=0.257) assessment.

Conclusions: In the United States, most AO/AOA patients receiving sequential therapy undergo RT followed by CT. No differences in survival were observed with either approach; this addresses a knowledge gap and confirms that both paradigms are appropriate in the first-line setting.

*Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE

Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO

Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX

§Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA

The authors declare no conflicts of interest.

Reprints: Vivek Verma, MD, Department of Radiation Oncology, Allegheny General Hospital, 320 East North Ave., Pittsburgh, PA 15212. E-mail:

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