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High grade gliomas. Multidisciplinar treatment with radiotherapy and concurrent carmustine after surgery

Gliomas de alto grado. Resultados del tratamiento multidisciplinar postoperatorio con radioterapia concomitante con carmustina

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Abstract

Introduction

Surgery and radiotherapy show an improvement in overall survival rates in the treatment of newly diagnosed malignant gliomas. The role of chemotherapy is uncertain. The aim of the present study was to evaluate toxicity and outcomes in patients with high-grade gliomas treated with carmustine (BCNU) concurrent with radiotherapy.

Material and methods

A descriptive single-arm study was conducted in patients with newly diagnosed high grade glioma who, post-surgery and concurrent with radiotherapy, had BCNU (200 mg/m2) administered on day 1 every 42 days.

Results

There were 43 patients (26 men and 17 women), median age of 54.5 years in the trial. Histology indicated glioblastoma in 36 patients (84%) and anaplastic astrocytoma in 7 patients (16%). Surgery was radical in 30 patients (70%) and non-radical in 13 (30%). Complete response (CR) was achieved in 13 patients (30%) by the conclusion of the treatment with 2 patients (5%) in partial response (PR). Progressive disease (PD) was recorded in 26 patients (60%). With a median follow-up 11 months, 8 patients (19%) are alive and disease free, 5 (12%) are alive with disease and 30 (70%) have expired. With a median time to progression of 7 months, median survival is 12 months and at 6 months the disease free survival is 53%. With 36 months of follow-up, the potential rate of long-term survival is 15% (10% in patients with glioblastoma). Toxicity grades 3–4 observed were: 16% leukopenia, 12% thrombopenia, 5% emesis and anaemia.

Conclusions

BCNU concurrent with radiotherapy is a well-tolerated and feasible regimen. Patients with radical surgery remain progression-free at the end of treatment in a 50% of cases. In cases in which surgery was non-radical, 2 partial responses were achieved (15%). We also obtained a satisfactory time-to-progression and overall survival.

Resumen

Introducción

El tratamiento con cirugía radical y radioterapia postoperatoria ha demostrado un incremento de la supervivencia en los pacientes afectos de gliomas de alto grado. La quimioterapia tiene un papel limitado. El propósito de este estudio es analizar la toxicidad y supervivencia en pacientes de alto grado tratados con carmustina (BCNU) concomitante con radioterapia.

Material y métodos

Estudio descriptivo no aleatorizado que incluye de forma prospectiva a los pacientes afectos de gliomas de alto grado. Tras la cirugía los pacientes recibieron: BCNU 200 mg/m2 día 1 cada 42 días concomitante con radioterapia.

Resultados

Cuarenta y tres pacientes (26 hombres, 17 mujeres), con una media de edad de 54,5 años, con glioblastoma multiforme en 36 pacientes (84%) y astrocitoma anaplásico en 7 pacientes (16%). Se realizó cirugía radical en 30 (70%) y no radical en 13 (30%). Trece pacientes se mantenían en remisión completa (RC) al finalizar el tratamiento, 2 alcanzaron remisión parcial (RP) (5%) y 26 pacientes progresaron (60%). Tras una mediana de seguimiento de 11 meses, 8 pacientes están vivos y sin enfermedad (19%), 5 viven con enfermedad (12%) y 30 (70%) han fallecido. La mediana de tiempo hasta la progresión fue de 7 meses y la mediana de supervivencia de 12 meses. La supervivencia libre de enfermedad a los 6 meses es del 53%. Tras 36 meses de seguimiento potencial exite un 15% de supervivientes (10% con glioblastoma multiforme). La toxicidad grado 3–4 ha sido escasa: 16% leucopenia, 12% trombopenia, 5% emesis y anemia.

Conclusiones

BCNU concomitante con radioterapia es un régimen de tratamiento bien tolerado y factible. En los pacientes con cirugía radical, el 50% permanecen sin progresión al final del tratamiento. En aquéllos en los que la cirugía no fue radical se obtuvieron dos respuestas parciales (15%). Los pacientes tienen un tiempo prolongado de supervivencia y supervivencia libre de progresión.

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References

  1. Yung A, Prados MD, Yaya-Tur R, et al. Multicenter Phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. J Clin Oncol 1999;17(9):2762–71.

    Article  CAS  Google Scholar 

  2. Burger PC, Vogel FS, Green SB, Strike TA. Glioblastoma multiforme and anaplastic astrocytoma: Pathologic criteria and prognostic implications. Cancer 1985;56:1106–11.

    Article  CAS  Google Scholar 

  3. Nelson JS, Tsukadada Y, Schoenfeld D, Fulling K, Lamarche J, Peress N. Necrosis as a prognostic criterion in malignant supratentorial, astrocytic gliomas. Cancer 1983;52550–4.

    Article  CAS  Google Scholar 

  4. Burton E, Prados M. New chemotherapy options for the treatment of malignant gliomas. Curr Opin Oncol 1999; 11:157–61.

    Article  CAS  Google Scholar 

  5. Fine HA, Dear KB, Loeffler JS, Black PM, Canellos GP. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 1993;71:2585–97.

    Article  CAS  Google Scholar 

  6. Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 1990;8:1277–80.

    Article  CAS  Google Scholar 

  7. Levin V, Silver P, Hannigan J, et al. Superiority of postradiotherapy adjuvant chemotherapy with CCNU procarbazine and vinciristine (PCN) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Radiat Oncol Biol Phys 1990;18:321–4.

    Article  CAS  Google Scholar 

  8. Prados M, Scott C, Curran W, Nelson D, Leibel S, Kramer S. PCV chemotherapy in anaplastic glioma: a retrospective review of radiation therapy oncology group (RTOG) protocols comparing survival with BCNU or PCV chemotherapy [abstract]. Neuro-oncology 1999;1: S47.

    Google Scholar 

  9. Byar DP, Green SB, Strike TA. Prognostic factors for malignant glioma. In: Walker MD, editor. Oncology of the nervous system. Boston: Martinus Nijhoff, 1983; p. 379.

    Chapter  Google Scholar 

  10. Burton EC, Prados MD. Malignant gliomas. Curr Treat Options Oncol 2000;1(5):459–68.

    Article  CAS  Google Scholar 

  11. Glioma Meta-analysis Trialist (GMT) Group. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002;359:1011–8.

    Article  Google Scholar 

  12. Brada M, Thomas DGT, Bleehen NM, et al. Medical Research Council (MRC) randomised trial of adjuvant chemotherapy in high grade glioma (HGG9-BR05) [abstract]. Proc Am Soc Clin Oncol 1998;17:400.

    Google Scholar 

  13. Grant R, Liang BC, Slaterry J, Greenberg HS, Junck L. Chemotherapy response criteria in malignant glioma. Neurology 1997;48:1336–40.

    Article  CAS  Google Scholar 

  14. Rao RD, Thome SD, O'Fallon J., Earle JD, Dinapoli RP, Buckner JC. Safety of thrice-daily hyperfractionated radiation and BCNU for high-grade gliomas. Int J Radiat Oncol Biol Phys 2002;53:376–84.

    Article  Google Scholar 

  15. Chan JL, Lee SW, Fraass BA, et al. Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy. J Clin Oncol 2002;20(6):1635–42.

    Article  Google Scholar 

  16. Gossman SA, O'Neill A, Grunnet M, et al. Phase III study comparing three cycles of infusional carmustine and cisplatin followed by radiation therapy with radiation therapy and concurrent carmustine in patients with newly diagnosed supratentorial glioblastoma multiforme: Earsten Cooperative Oncology Group Trial 2394. J Clin Oncol 2003;21:1485–91.

    Article  Google Scholar 

  17. Selker RG, Shapiro WR, Burger P, et al. The Brain Tumor Cooperative Group NIH Trial 87–01: a randomized comparison of surgery, external radiotherapy and carmustine versus surgery, interstitial radiotherapy boost, external radiation therapy and carmustine. Neurosurgery 2002:51:343–55.

    Article  Google Scholar 

  18. Couglin C, Scott C, Langer C, Coia L, Curran W, Rubin P.. Phase ii, two arm RTOG trial (94–11) of bischloroethyl-nitrosourea plus accelerated hyperfractionated radiotherapy (64 or 70 Gy) based on tumor volume (>20 or<or=20 cm2, respectively) in the treatment of newly-diagnosed radiosurgery-ineligible glioblastoma multiforme patients. Int J Radiat Oncol Biol Phys 2000;48:1351–8.

    Article  Google Scholar 

  19. Kleinberg L, Grossman SA, Piantadosi S, Zeltzman M, Wharam M. The effects of sequential versus concurrent chemotherapy abd radiotherapy on survival and toxicity in patients with newly diagnosed high-grade astrocytoma. Int J Radiat Oncol Biol Phys 1999;44:535–43.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Medical Oncology Unit, University Hospital La Fe, Avda. Campanar 21, 46009, Valencia, Spain

    José Pérez-Fidalgo, Ángel Segura, Gaspar Reynés, Verónica Calderero & Roberto Díaz-Beveridge

  2. Radiation Therapy Unit, University Hospital La Fe, Valencia, Spain

    Román Amador

Authors
  1. José Pérez-Fidalgo
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  2. Ángel Segura
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  3. Gaspar Reynés
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  4. Román Amador
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  5. Verónica Calderero
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  6. Roberto Díaz-Beveridge
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Correspondence to Ángel Segura.

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Pérez-Fidalgo, J., Segura, Á., Reynés, G. et al. High grade gliomas. Multidisciplinar treatment with radiotherapy and concurrent carmustine after surgery. Rev Oncol 6, 207–211 (2004). https://doi.org/10.1007/BF02711724

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  • DOI: https://doi.org/10.1007/BF02711724

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