Myeloablative chemotherapy for recurrent aggressive oligodendroglioma.

Area of Science:

• Neuro-oncology
• Hematology
• Clinical Oncology

Background:

• Recurrent oligodendrogliomas often present aggressive behavior after initial treatments.
• Effective salvage therapies for recurrent oligodendrogliomas are limited, necessitating investigation into intensive treatment strategies.

Purpose of the Study:

• To evaluate the efficacy and toxicity of dose-intense myeloablative chemotherapy using thiotepa in patients with recurrent oligodendrogliomas.
• To determine the duration of tumor control and survival outcomes following this intensive treatment regimen.

Main Methods:

• Patients with contrast-enhancing, measurable, and aggressive recurrent oligodendrogliomas, previously irradiated, were eligible.
• Eligible patients received induction chemotherapy followed by high-dose thiotepa (300 mg/m2/day for 3 days) and hematopoietic stem cell rescue.
• Thirty-eight patients started induction, and 20 proceeded to high-dose thiotepa.

Main Results:

• The median event-free, progression-free, and overall survival from recurrence were 17, 20, and 49 months, respectively, for the 20 patients receiving high-dose thiotepa.
• Tumor control exceeding 2 years was achieved in 30% of patients, with 20% alive and tumor-free at long-term follow-up.
• However, 20% of patients experienced fatal toxicities, including progressive encephalopathy and intracerebral hemorrhage, particularly in those with lower Karnofsky scores.

Conclusions:

• High-dose thiotepa as consolidation therapy for recurrent aggressive oligodendrogliomas yielded disappointing overall efficacy despite some durable responses.
• The treatment was associated with significant, potentially fatal toxicities, especially in previously irradiated patients with poor performance status.
• This intensive strategy may not be suitable for the general population of patients with recurrent oligodendrogliomas.