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Radiation
therapy and bromodeoxyuridine chemotherapy followed by procarbazine, lomustine,
and vincristine for the treatment of anaplastic gliomas
Levin
VA, Prados MR, Wara WM, Davis RL, Gutin PH, Phillips TL, Lamborn K, Wilson CB
Northern
California Cancer Center, Union City, USA
Purpose.
To conduct a Phase II study to evaluate the long-term efficacy and safety of
radiotherapy combined with intravenous bromodeoxyuridine for patients with
anaplastic glioma tumors.
Methods
and Materials. Between 1983 and 1987, study patients received 1.7-1.8 Gy
radiation once a day, Monday through Friday, to a total dose of 60 Gy.
On the Thursday prior to beginning radiotherapy and for the next 5 weeks (6
weeks total), patients received a continuous 96 h intravenous infusion of
bromodeoxyuridine at 0.8 g/m2/24 h; following radiotherapy, patients received
procarbazine, lomustine (CCNU), and vincristine (PCV) for 1 year or until tumor
progressed.
Results.
One-hundred thirty eight patients (median age, 43 years) were evaluable for
analysis.
Estimated 4-year survival for the anaplastic astrocytoma (AA) stratum (n = 116)
is 46%.
For the astrocytoma (ASTRO) stratum (n = 22), the 6-year survival is estimated
at 79%.
Estimated 4-year progression-free survival for AAs is 42%, and for ASTROs,
68%.
Whole brain irradiation was used in 23% and limited-field irradiation in 77%;
patients receiving limited-field irradiation had a better survival rate (p =
0.07).
Total tumor resection was performed in 15%, partial resection in 53%, and biopsy
only in 32%.
For the 81 patients with tumor recurrence, 34 (42%) are known to have received
additional treatment(s).
For AA, fits of the Cox proportional hazards regression model showed that
covariates individually predictive of survival were younger age (p < 0.001),
Karnofsky performance score (p = 0.10).
Major toxicities were rash during Weeks 1 through 6 requiring dose modification
in 14%, Grade > or = III leukopenia in 18%, and Grade > or = III
thrombocytopenia in 9%.
Conclusion.
The study suggests that the bromodeoxyuridine-radiotherapy-PCV, compared with
other published therapies, can improve progression-free survival, and aggressive
treatment of ASTRO patients can lead to substantial increases in survival
compared to published survival data.
PMID:
7721642 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7721642&dopt=Abstract |
