Chemotherapy and Radiotherapy for Anaplastic Gliomas

Anaplastic gliomas, comprising primarily grade III oligodendrogliomas and astrocytomas, represent a heterogeneous group of high-grade primary brain tumours with variable prognosis. Optimal management requires maximal safe surgical resection followed by adjuvant radiotherapy and systemic chemotherapy. Radiotherapy, delivered in fractionated doses to the tumour bed and peritumoral margins, remains essential for local control, while chemotherapy regimens such as procarbazine, lomustine and vincristine (PCV) or temozolomide (TMZ) enhance progression-free survival. Molecular profiling—most notably isocitrate dehydrogenase (IDH) mutation status and 1p/19q codeletion—guides therapeutic decisions, predicts sensitivity to alkylating agents and informs risk stratification. Recent advances include refinement of radiotherapy volumes to reduce neurotoxicity, personalized dosing schedules to mitigate haematological and cognitive side effects, and integration of molecular signatures into clinical algorithms. Despite improvements in median survival, long-term disease control remains challenging, emphasising the need for tailored combinations of radiotherapy and chemotherapy based on individual tumour biology and patient factors.

Research from Nature Portfolio

Analyses of recurrence patterns in grade III gliomas have shown that local failures predominantly occur within the high-dose radiotherapy volume, underscoring the importance of meticulous delineation of gross tumour and clinical target volumes. Patterns differ according to extent of resection and molecular subtype, with complete resection and favourable IDH-mutant, 1p/19q-codeleted status linked to lower in-field relapse rates. Concurrently, a large retrospective study of 95 anaplastic oligodendroglioma patients identified key prognostic factors influencing both progression-free and overall survival. Younger age, frontal lobe location, weak contrast enhancement on imaging and gross total resection emerged as positive predictors, alongside IDH-mutant and 1p/19q-codeleted genotypes. These findings have informed risk-adapted approaches to radiotherapy dose escalation and the selection of chemotherapy backbones, reinforcing molecular profiling as indispensable in therapeutic planning.

Chemotherapy and Radiotherapy for Anaplastic Gliomas publication trend

The graph below shows the total number of articles in chemotherapy and radiotherapy for anaplastic gliomas across all publications each year (not limited to Nature Index journals).

Technical terms

Anaplastic glioma: WHO grade III primary brain tumour of astrocytic or oligodendroglial origin.

Radiotherapy: Localised treatment using ionising radiation to eradicate tumour cells.

Chemotherapy: Systemic administration of cytotoxic agents, including PCV (procarbazine, lomustine, vincristine) and temozolomide.

Progression-free survival (PFS): Interval from treatment initiation to documented tumour progression.

Overall survival (OS): Duration from diagnosis or treatment start to death from any cause.

Gross total resection (GTR): Surgical removal of all visible tumour on postoperative imaging.

IDH mutation: Genetic alteration in isocitrate dehydrogenase enzymes linked to improved prognosis.

1p/19q codeletion: Concurrent loss of chromosomal arms 1p and 19q, predictive of chemosensitivity.

References

1. Recurrence patterns after maximal surgical resection and postoperative radiotherapy in anaplastic gliomas according to the new 2016 WHO classification. Scientific Reports (2018).
2. Survival outcome and prognostic factors in anaplastic oligodendroglioma: a single-institution study of 95 cases. Scientific Reports (2020).
3. Joint Final Report of EORTC 26951 and RTOG 9402: Phase III Trials With Procarbazine, Lomustine, and Vincristine Chemotherapy for Anaplastic Oligodendroglial Tumors. Journal of Clinical Oncology (2022).
4. CODEL: phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p/19q codeleted oligodendroglioma. Analysis from the initial study design. Neuro-Oncology (2020).
5. A single institution retrospective analysis on survival based on treatment paradigms for patients with anaplastic oligodendroglioma. Journal of Neuro-Oncology (2021).