Temozolomide and Radiation Therapy in Treating Patients With Gliomas

DISEASE CHARACTERISTICS:

• Histologically confirmed* supratentorial glioma of 1 of the following histologies:

  • Astrocytoma (diffuse fibrillary, protoplasmic, or gemistocytic)
  • Oligodendroglioma
  • Oligoastrocytoma NOTE: *Histologic atypia allowed provided no other histologic features (i.e., frequent mitoses, endothelial proliferation, and/or acute necrosis) that would result in a designation of anaplastic astrocytoma, anaplastic mixed oligodendroglioma or oligoastrocytoma, or glioblastoma multiforme are present
• Unifocal or multifocal disease
• WHO grade II disease
• Neurofibromatosis allowed

• Surgical biopsy or resection for tumor tissue sampling required within the past 12 weeks

  • Tissue block or core biopsy available for O6-methylguanine-DNA methyltransferase analysis and tissue banking
  • Patients who have only had a stereotactic biopsy are not eligible

• Must have ≥ 3 of the following risk factors:

  • Age 40 and over
  • Largest preoperative tumor diameter ≥ 6 cm
  • Tumor crosses the midline
  • Astrocytoma-dominant tumor subtype
  • Preoperative Neurological Function Status > 1

• No other low-grade glioma histologies, including any of the following:

  • Pilocytic astrocytoma
  • Subependymal giant cell astrocytoma of tuberous sclerosis
  • Subependymoma
  • Pleomorphic xanthoastrocytoma
  • Presence of a neuronal element, such as ganglioglioma
  • Dysneuroembryoplastic epithelial tumor

• No high-grade glioma, including any of the following:

  • Anaplastic astrocytoma
  • Glioblastoma multiforme
  • Anaplastic oligodendroglioma
  • Anaplastic oligoastrocytoma

• No tumors in any nonsupratentorial location, including any of the following:

  • Optic chiasm
  • Optic nerve(s)
  • Pons
  • Medulla
  • Cerebellum
  • Spinal cord

• No evidence of disease progression to spinal meninges or noncontiguous cranial meninges (i.e., leptomeningeal gliomatosis) by MRI of the spine or cerebrospinal fluid (CSF) cytology

  • MRI of the spine or CSF cytology are not required for patients without symptoms of spinal/cranial meningeal disease progression

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• Zubrod 0-2

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3

Hepatic

• Total bilirubin ≤ 1.5 mg/dL
• Serum glutamate oxaloacetate transaminase (SGOT) or Serum glutamate pyruvate transaminase (SGPT) ≤ 2 times normal
• Alkaline phosphatase ≤ 2 times normal

Renal

• Serum creatinine ≤ 1.5 mg/dL

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No known HIV positivity
• No other malignancy within the past 5 years except carcinoma in situ of the cervix or nonmelanoma skin cancer
• No active infection

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No concurrent immunotherapy or biologic therapy

Chemotherapy

• No prior chemotherapy
• No other concurrent chemotherapy

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy to the head and neck unless head and neck radiotherapy clearly excluded the brain (e.g., localized radiotherapy to the vocal cords)
• No prior radiotherapy to the brain
• No concurrent intensity modulated radiotherapy
• No concurrent stereotactic boost radiotherapy

Surgery

• See Disease Characteristics

Other

• No other concurrent investigational agents