Chromosomal tests can determine brain tumor therapy, outcomes, Jefferson oncologists find

Philadelphia- A trial involving two types of rare, malignant but treatable brain tumors shows that missing portions of two chromosomes can predict which patients will likely do better with therapy. The results, says senior author Walter J. Curran Jr., M.D., professor and chair of radiation oncology at Jefferson Medical College of Thomas Jefferson University in Philadelphia, represents a paradigm shift in treating such tumors, known as gliomas.

Reporting last week in the Journal of Clinical Oncology, Dr. Curran and a team of American and Canadian researchers, in conjunction with the Philadelphia-based Radiation Therapy Oncology Group (RTOG), a federally-supported clinical trials organization, found that among 289 patients with either anaplastic oligodendroglioma or anaplastic oligoastrocytoma receiving either a combination of three chemotherapy drugs with radiation or radiation alone, those whose tumors had deletions in chromosome locations 1p and 19q tended to live nearly two and a half times longer than those patients without the missing chromosome portions. The "median survival time" of patients with the deletions was greater than seven years, meaning that one-half lived at least that long. For those with tumors lacking such deletions, one-half lived at least 2.8 years.

"Leukemias used to be the only cancers where chromosomal deletions were part of the treatment decision-making process," says Dr. Curran, who is also clinical director of the Kimmel Cancer Center at Jefferson. "Now, testing for such deletions in tumors should become mandatory for at least these types of gliomas."

In the study, 147 patients received the chemotherapy and radiation, while 142 were given only radiation. These rare, malignant tumors can be effectively treated, though seldom "cured" with surgery and radiation. One controversy, explains Dr. Curran, was whether or not adding chemotherapy early in the treatment will help individuals live longer.

Contact: Steve Benowitz
Thomas Jefferson University

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