A 45-year-old patient with IDH-mutant, 1p/19q co-deleted grade 3 oligodendroglioma undergoes maximal safe resection. Which adjuvant treatment protocol is currently supported by the CATNON and CODEL trials?

• A Radiotherapy alone (60 Gy in 30 fractions)
• B Temozolomide chemotherapy alone without radiotherapy
• C Radiotherapy followed by PCV chemotherapy (procarbazine, lomustine, vincristine) ✓
• D Radiotherapy plus concurrent and adjuvant temozolomide (Stupp protocol)

Explanation

For IDH-mutant 1p/19q co-deleted oligodendroglioma (grade 2 or 3), the RTOG 9802 and CODEL trials established that radiotherapy followed by PCV chemotherapy (procarbazine, CCNU/lomustine, vincristine) significantly improves overall survival and progression-free survival compared to radiotherapy alone. The 2016 WHO CNS classification mandates 1p/19q co-deletion as a defining criterion for oligodendroglioma. PCV post-RT is the standard of care per NCCN and EANO guidelines. The Stupp protocol (temozolomide concurrent with RT) applies to IDH-wildtype glioblastoma; CATNON evaluated temozolomide for non-co-deleted anaplastic glioma (IDH-mutant 1p/19q intact).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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