Vanderbilt-Ingram Cancer Center

The purpose of this study is to compare the effects, good and/or bad, of adding the chemotherapy pill temozolomide to radiation. Radiation is the commonly used initial intervention for this type of tumor. Temozolomide is an oral, well-tolerated chemotherapy agent that readily crosses the intact blood-brain barrier and has activity against even the most aggressive gliomas. Recent studies have indicated that temozolomide, either as the initial treatment or in tumors that have started to grow following radiation, often helps stop the growth of low-grade gliomas. In this study, the patient will get either radiation therapy alone or radiation therapy with temozolomide. It is hoped that the combination of two therapies will improve the outcome of treatment of these tumors.

Criteria
 DISEASE CHARACTERISTICS:

 • Histologically confirmed* supratentorial low-grade glioma, including 1 of the following:

 • Grade 2 astrocytoma

 • Grade 2 oligodendroglioma

 • Grade 2 oligoastrocytoma (mixed glioma containing astrocytoma and oligodendroglioma)

 • NOTE: *If the pathology from multiple procedures supports the diagnosis of a brain tumor, the qualifying pathology of grade 2 astrocytoma, oligodendroglioma, or oligoastrocytoma must be the most recent pathological diagnosis; no pathological diagnosis of grade 3 or 4 glioma at any time

 • Paraffin-embedded tumor specimen available for submission for confirmation of pathological review and determination of 1p and 19q deletion status

 • Patients must currently meet ≥ 1 of the following criteria*:

 • Uncontrolled symptoms, defined as any of the following:

 • Headaches associated with mass effect

 • Uncontrolled seizures despite two different antiepileptic drug regimens (i.e., two antiepileptic drugs tested either sequentially or in combination)

 • Focal neurological symptoms

 • Cognitive symptoms or deficits

 • Tumor progression by serial MRIs, defined as any of the following:

 • New or progressive enhancement

 • New or progressive T2 or FLAIR signal abnormality

 • Age ≥ 40 years

 • NOTE: *Patients < 40 years of age whose only symptom of low-grade glioma is seizures that are well-controlled on antiepileptic drugs AND who have no evidence of radiographic progression are not eligible.

 • Patients who have undergone gross total resection and have no detectable residual disease are eligible

 • No pilocytic astrocytoma, ganglioglioma, pleomorphic xanthoastrocytoma, or dysembryoplastic neuroepithelial tumors

 PATIENT CHARACTERISTICS:

 • Karnofsky performance status 60-100%

 • WBC ≥ 3,000/mm^3

 • ANC ≥ 1,500/mm^3

 • Platelet count ≥ 100,000/mm^3

 • Hematocrit ≥ 30%

 • Bilirubin ≤ 2 times upper limit of normal (ULN)

 • AST and ALT ≤ 3 times ULN

 • Creatinine ≤ 2.0 times ULN

 • Not pregnant or nursing

 • Negative pregnancy test

 • Able to undergo MRI with and without contrast

 • No other malignancy within the past 5 years, except for nonmelanoma skin cancer or cervical carcinoma in situ

 • No uncontrolled infection

 • No known HIV positivity

 • No medical disorder that would increase risks associated with radiotherapy and temozolomide

 • No other disorder that would limit life expectancy to < 5 years

 PRIOR CONCURRENT THERAPY:

 • No prior radiotherapy, cytotoxic chemotherapy, radiosurgery, or investigational therapy directed at the brain tumor

 • Any number of prior surgical procedures for the brain tumor allowed

 • No prior radiotherapy to the head unless the radiotherapy ports entirely excluded the brain

 • At least 2 weeks since any prior brain surgery (e.g., stereotatic biopsy, open biopsy, or resection)

 • At least 6 weeks since prior MRI and chest x-ray

 • If resection is performed, an MRI after surgery is required