Neurological Surgery 脳神経外科51巻5号

2023年09月発行

特集 臨床脳神経外科医にとってのWHO脳腫瘍分類第5版 Ⅱ 成人悪性脳腫瘍

乏突起膠腫，IDH変異かつ1p/19q共欠失

著者： 松谷智郎¹

所属機関： ¹千葉大学大学院医学研究院脳神経外科学

ページ範囲：P.811 - P.820

Point
・乏突起膠腫はWHO脳腫瘍分類改訂第4版以後，IDH変異と1p/19q共欠失を伴う，より均一な予後良好な腫瘍として分類されるようになった．
・しかし推奨治療は，形態診断時代に行われた臨床試験の結果により提唱されている．
・これら過去の臨床試験のもつ意味を正しく理解しつつ，今後明らかとなる臨床試験結果を見据えた治療戦略が求められる．

参考文献

1）Parsons DW, et al：An integrated genomic analysis of human glioblastoma multiforme. Science 321：1807-1812, 2008

mutations in gliomas. N Engl J Med 360：765-773, 2009

3）Brat DJ, et al；Cancer Genome Atlas Research Network：Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med 372：2481-2498, 2015

promoter mutations in tumors. N Engl J Med 372：2499-2508, 2015

5）Suzuki H, et al：Mutational landscape and clonal architecture in grade Ⅱ and Ⅲ gliomas. Nat Genet 47：458-468, 2015

6）Kim YH, et al：Molecular classification of low-grade diffuse gliomas. Am J Pathol 177：2708-2714, 2010

promoter define clinically distinct subgroups of adult malignant gliomas. Oncotarget 5：1515-1525, 2014

8）Brain tumor registry of Japan（2005-2008）. Neurol Med Chir（Tokyo）57（Suppl 1）：9-102, 2017

9）Harary M, et al：Predictors and early survival outcomes of maximal resection in WHO grade Ⅱ 1p/19q-codeleted oligodendrogliomas. Neuro Oncol 22：369-380, 2020

10）Kinslow CJ, et al：Extent of resection and survival for oligodendroglioma：a U.S. population-based study. J Neurooncol 144：591-601, 2019

11）Kavouridis VK, et al：Contemporary assessment of extent of resection in molecularly defined categories of diffuse low-grade glioma：a volumetric analysis. J Neurosurg 133：1291-1301, 2020

12）Yordanova YN, et al：Awake surgery for WHO grade Ⅱ gliomas within “noneloquent” areas in the left dominant hemisphere：toward a “supratotal” resection. Clinical article. J Neurosurg 115：232-239, 2011

13）Duffau H：Long-term outcomes after supratotal resection of diffuse low-grade gliomas：a consecutive series with 11-year follow-up. Acta Neurochir（Wien）158：51-58, 2016

14）Kreatsoulas D, et al：Supratotal surgical resection for low-grade glioma：a systematic review. Cancers（Basal）15：2493, 2023　doi:10.3390/cancers15092493

15）Weller M, et al：EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol 18：170-186, 2021

16）Mohile NA, et al：Therapy for diffuse astrocytic and oligodendroglial tumors in adults：ASCO-SNO guideline. J Clin Oncol 40：403-426, 2022

17）Buckner JC, et al：Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 374：1344-1355, 2016

18）van den Bent MJ, et al：Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults：the EORTC 22845 randomised trial. Lancet 366：985-990, 2005

19）Cairncross G, et al：Phase Ⅲ trial of chemoradiotherapy for anaplastic oligodendroglioma：long-term results of RTOG 9402. J Clin Oncol 31：337-343, 2013

20）van den Bent MJ, et al：Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma：long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 31：344-350, 2013

21）Cairncross G, et al；Intergroup Radiation Therapy Oncology Group T：Phase Ⅲ trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma：Intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol 24：2707-2714, 2006

22）van den Bent MJ, et al：Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas：a randomized European Organisation for Research and Treatment of Cancer phase Ⅲ trial. J Clin Oncol 24：2715-2722, 2006

23）Hata N, et al：Deferred radiotherapy and upfront procarbazine-ACNU-vincristine administration for 1p19q codeleted oligodendroglial tumors are associated with favorable outcome without compromising patient performance, regardless of WHO grade. OncoTargets Ther 9：7123-7131, 2016

24）Iwadate Y, et al：Eighty percent survival rate at 15 years for 1p/19q co-deleted oligodendroglioma treated with upfront chemotherapy irrespective of tumor grade. J Neurooncol 141：205-211, 2019

25）Mikkelsen T, et al：Temozolomide single-agent chemotherapy for newly diagnosed anaplastic oligodendroglioma. J Neurooncol 92：57-63, 2009

26）Vogelbaum MA, et al：Phase Ⅱ trial of preirradiation and concurrent temozolomide in patients with newly diagnosed anaplastic oligodendrogliomas and mixed anaplastic oligoastrocytomas：RTOG BR0131. Neuro Oncol 11：167-175, 2009

27）Fisher BJ, et al：Phase 2 study of temozolomide-based chemoradiation therapy for high-risk low-grade gliomas：preliminary results of Radiation Therapy Oncology Group 0424. Int J Radiat Oncol Biol Phys 91：497-504, 2015

28）Touat M, et al：Mechanisms and therapeutic implications of hypermutation in gliomas. Nature 580：517-523, 2020

29）Hafazalla K, et al：Procarbazine, CCNU and vincristine（PCV）versus temozolomide chemotherapy for patients with low-grade glioma：a systematic review. Oncotarget 9：33623-33633, 2018

30）Douw L, et al：Cognitive and radiological effects of radiotherapy in patients with low-grade glioma：long-term follow-up. Lancet Neurol 8：810-818, 2009

31）Cayuela N, et al：Cognitive and brain structural changes in long-term oligodendroglial tumor survivors. Neuro Oncol 21：1470-1479, 2019

32）Lin AJ, et al：A multi-institutional analysis of clinical outcomes and patterns of care of 1p/19q codeleted oligodendrogliomas treated with adjuvant or salvage radiation therapy. J Neurooncol 146：121-130, 2020

33）Weller J, et al：PCV chemotherapy alone for WHO grade 2 oligodendroglioma：prolonged disease control with low risk of malignant progression. J Neurooncol 153：283-291, 2021

34）Wick W, et al；Neurooncology Working Group（NOA）of the German Cancer Society：Long-term analysis of the NOA-04 randomized phase Ⅲ trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide. Neuro Oncol 18：1529-1537, 2016

35）Baumert BG, et al：Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma（EORTC 22033-26033）：a randomised, open-label, phase 3 intergroup study. Lancet Oncol 17：1521-1532, 2016

36）Herrlinger U, et al；Neurooncology Working Group of the German Cancer Society：Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter（CeTeG/NOA-09）：a randomised, open-label, phase 3 trial. Lancet 393：678-688, 2019

37）Mellinghoff IK, et al：Vorasidenib in IDH1- or IDH2-mutant low-grade glioma. N Engl J Med 389：589-601, 2023