Radiation therapy oncology group 9802: Controversy or consensus in the treatment of newly diagnosed low-grade glioma?

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Abstract

Treatment of newly diagnosed or suspected low-grade glioma (LGG) is one of the most controversial areas in neuro-oncology. The heterogeneity of these tumors, concern regarding morbidity of treatment, and absence of proven overall survival benefit from any known treatment have resulted in a lack of consensus regarding the timing and extent of surgery, timing of radiotherapy (RT), and role of chemotherapy. The long-term results of Radiation Therapy Oncology Group (RTOG) 9802, a phase III randomized trial comparing RT alone with RT and 6 cycles of adjuvant procarbazine, CCNU, vincristine (PCV), demonstrated an unprecedented 5.5-year improvement in median overall survival with the addition of PCV chemotherapy in high-risk patients with LGG. These results are practice changing and define a new standard of care for these patients. However, in the intervening decade since the trial was completed, novel molecular markers as well as newer chemotherapy agents such as temozolomide have been developed, which make these results difficult to incorporate into clinical practice. This review summarizes the evidence for and against the role of upfront RT and PCV in newly diagnosed patients with LGG.

Original languageEnglish (US)
Pages (from-to)197-202
Number of pages6
JournalSeminars in Radiation Oncology
Volume25
Issue number3
DOIs
StatePublished - 2015

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Radiation Oncology
Glioma
Lomustine
Procarbazine
Radiotherapy
Vincristine
temozolomide
Drug Therapy
Therapeutics
Survival
Standard of Care
Morbidity
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

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title = "Radiation therapy oncology group 9802: Controversy or consensus in the treatment of newly diagnosed low-grade glioma?",
abstract = "Treatment of newly diagnosed or suspected low-grade glioma (LGG) is one of the most controversial areas in neuro-oncology. The heterogeneity of these tumors, concern regarding morbidity of treatment, and absence of proven overall survival benefit from any known treatment have resulted in a lack of consensus regarding the timing and extent of surgery, timing of radiotherapy (RT), and role of chemotherapy. The long-term results of Radiation Therapy Oncology Group (RTOG) 9802, a phase III randomized trial comparing RT alone with RT and 6 cycles of adjuvant procarbazine, CCNU, vincristine (PCV), demonstrated an unprecedented 5.5-year improvement in median overall survival with the addition of PCV chemotherapy in high-risk patients with LGG. These results are practice changing and define a new standard of care for these patients. However, in the intervening decade since the trial was completed, novel molecular markers as well as newer chemotherapy agents such as temozolomide have been developed, which make these results difficult to incorporate into clinical practice. This review summarizes the evidence for and against the role of upfront RT and PCV in newly diagnosed patients with LGG.",
author = "Laack, {Nadia N} and Sarkaria, {Jann N} and Buckner, {Jan Craig}",
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AU - Buckner, Jan Craig

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AB - Treatment of newly diagnosed or suspected low-grade glioma (LGG) is one of the most controversial areas in neuro-oncology. The heterogeneity of these tumors, concern regarding morbidity of treatment, and absence of proven overall survival benefit from any known treatment have resulted in a lack of consensus regarding the timing and extent of surgery, timing of radiotherapy (RT), and role of chemotherapy. The long-term results of Radiation Therapy Oncology Group (RTOG) 9802, a phase III randomized trial comparing RT alone with RT and 6 cycles of adjuvant procarbazine, CCNU, vincristine (PCV), demonstrated an unprecedented 5.5-year improvement in median overall survival with the addition of PCV chemotherapy in high-risk patients with LGG. These results are practice changing and define a new standard of care for these patients. However, in the intervening decade since the trial was completed, novel molecular markers as well as newer chemotherapy agents such as temozolomide have been developed, which make these results difficult to incorporate into clinical practice. This review summarizes the evidence for and against the role of upfront RT and PCV in newly diagnosed patients with LGG.

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