Radiation plus PCV improves long-term overall survival in patients with low grade glioma

New England Journal of Medicine

As a follow-up to the 2012 results of a randomized Phase III trial adding procarbazine, lomustine (CCNU), and vincristine (PCV) chemotherapy after radiotherapy for newly-diagnosed patients with WHO grade II glioma, this new report details the long-term results after 12 years of median clinical follow-up.  Patients were randomly assigned to postoperative radiotherapy vs radiotherapy plus PCV.  The results indicate that the combined therapy regimen substantially improves overall survival for low-grade glioma patients under 40 years following biopsy/subtotal resection or any low-grade glioma patient over 40 years of age.   The median overall survival of was 5.5 years longer (13.3 years versus 7.8 years) in patients who received the combination therapy (P=0.003).  While these results suggest the combined regimen should be considered the new standard-of-care for low-grade gliomas, questions such as the long-term neurocognitive effects, the comparability of temozolomide, as well as the underlying genetics of this effect remain to be answered. 

Nader Sanai, MD
Phoenix, AZ