P10.11 Adjuvant Temozolomide and radiation for Anaplastic Oligodendroglioma: A single center experience

Abstract

BACKGROUND: Adjuvant management of anaplastic Oligodendroglial tumors (AOTs) is controversial. Outcomes with temozolomide (TMZ)-based adjuvant chemo-radiation (ACRT) have been inadequately explored. METHODS: We analysed our database between 2000 and 2014. All patients were treated with maximally safe surgical resection followed by post-operative radiation. Radiation dose was 60 Gy in 30 fractions. Patients treated after 2007 also received concurrent daily temozolomide(TMZ) (75 mg/ m2) then four weeks later, adjuvant TMZ started at 150 mg/m2 day 1 to 5 every 28 days and escalated to 200 mg/m2 after the 2nd cycle. Kaplan Meier method was used to estimate survival, and the impact of various factors on survival of patients with ODG was estimated using log rank. RESULTS: We analysed data of 81 patients. Median age was 40 years (Range: 7-77 years). 39 (48.1%) underwent gross/near total resection; 26 (32.1%) underwent a subtotal resection; 14(17.3%) underwent decompression and 2(2.5%) patient had unknown resection status. Median MIB labelling index was 20 (Range: 5-45).Median radiotherapy dose was 60 Gy (Range 40-60). 50 patients (61.7%) received concurrent chemotherapy while 44(54.3%) also received adjuvant chemotherapy. In patients receiving temozolomide based chemoradiation grade III or IV thrombocytopenia was noted in 10% cases, and 2% had grade III or IV neutropenia.Median number of adjuvant chemotherapy cycles was 6 (range: 1 to 12). Median follow-up was 25 months. Estimated median progression free survival (PFS) was 5.2 years. 2 and 5 year PFS were 76.2% and 50.5% respectively. Median overall survival was 6.71 years. Univariate analysis for prognostic factors influencing survival did not find any significant factor associated with better survival in anaplastic ODG. CONCLUSION: Adjuvant Temozolomide with radiation is a safe and feasible approach in the treatment of anaplastic ODG and should be evaluated in randomized trial.