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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016

Part 4 is a guide to the treatment options

for adults with oligodendrogliomas and

oligoastrocytomas. Also, you may have

an option of joining a clinical trial. This

information is taken from the treatment

guidelines written by NCCN experts for

doctors treating gliomas. Your doctors

may suggest other treatments than those

listed in Part 4 based on your health and

personal wishes.

Grade II

The best treatment for grade II oligodendrogliomas

and oligoastrocytomas still needs to be confirmed. At

this time, surgery is still very important for diagnosis

and treatment. The first goal of surgery is to remove

enough tissue for diagnosis and cancer grading.

Guide 12

lists treatment options for grade II

oligodendrogliomas and oligoastrocytomas. Your

surgeon will assess how much of the tumor he or

she can remove. The amount that will be removed

depends on where the tumor is, your age and health,

and other factors. Your surgeon does not want you

less able to think, speak, and move afterward.

Maximal safe resection

A maximal safe resection is a treatment plan to

remove all or most of the tumor as is safe. Hopefully,

the whole tumor will be removed. Many grade II

oligodendrogliomas can be fully removed. Removal

of the whole tumor is called a gross total resection.

However, your surgeon may decide during surgery

that the whole tumor can’t be removed. Removing

only part of the tumor is called a subtotal resection.

Other surgeries

Sometimes, the tumor can’t be fully removed

because it is in a key area of the brain. There are

other options if it is known before surgery that

a maximal safe resection can’t be done. These

options are a subtotal resection, open biopsy, and

stereotactic biopsy.


Surgery is advised in general. However, for some

people, observation may be an option. Observation

consists of one or more cancer tests repeated over a

period of time. Treatment to remove the cancer or to

relieve symptoms may be started if the status of the

cancer changes.

Tests after surgery

The removed tissue will be sent to a pathologist for

testing. The pathologist will confirm if there’s cancer,

and if so, the cancer grade. Molecular markers of

gliomas will also be assessed.

You should receive a brain MRI if you had a gross

total or subtotal resection. MRI should be done within

24 to 72 hours after surgery. Images will be made

with and without contrast. This test can confirm how

much of the cancer was removed. If you can’t have

MRI, you may receive a CT scan with and without


Post-surgery treatment

Guide 12 also lists options for treatment after

surgery. Options are mainly based on what type

of surgery you had. Molecular makers also are

important in some cases.

You may have had a gross total resection and are 40

years of age or younger. In this case, you may have

3 options. You may be able to start observation and

wait to see if more treatment is needed.

Other options include receiving fractionated EBRT or

chemotherapy now. PCV or temozolomide is advised

for chemotherapy. Chemotherapy may have good

results for grade II oligodendroglioma, especially

if the cells have 1p19q deletions. However, more

research is needed to know for certain.


Oligodendrogliomas and oligoastrocytomas Grade II