What is the Sequence of Chemoradiation?

NOA-04 phase III trial randomised 318 patients with anaplastic glioma to receive RT (arm A), PCV (arm B1) or temozolomide (arm B2) at diagnosis. 13At unacceptable toxicity or disease progression, arm A was randomised to receive PCV or temozolomide, whereas arm B1 or B2 received RT. The study examined a total of 274 patients with anaplastic glioma (144 anaplastic astrocytoma, 91 anaplastic oligoastrocytoma, 39 anaplastic oligodendroglioma) using a modified intention-to-treat analysis, and demonstrated no significant difference in time-to-treatment failure (TTF), PFS and OS among the 3 treatment arms. Hence, PCV or temozolomide can be an upfront treatment option to defer RT treatment in a selected group of patients with anaplastic glioma.


To the best of our knowledge, there are no cost-effectiveness analyses available for systemic therapy in anaplastic glioma.