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Phase
II study of accelerated fractionation radiation therapy with carboplatin
followed by vincristine chemotherapy for the treatment of glioblastoma
multiforme
Levin VA, Maor MH, Thall PF, Yung WK, Bruner J, Sawaya R, Kyritsis AP, Leeds
N, Woo S, Rodriguez L, et al
Department of Neuro-Oncology, University of Texas M. D. Anderson
Cancer Center, Houston 77030, USA
Purpose. To conduct a Phase II one-arm study to evaluate the long-term
efficacy and safety of accelerated fractionated radiotherapy combined with
intravenous carboplatin for patients with previously untreated glioblastoma
multiforme tumors.
Methods
and Materials. Between 1988 and 1992, 83 patients received 1.9-2.0 Gy
radiation three times a day with 2-h infusions of 33 mg/m2 carboplatin for two
5-day cycles separated by 2 weeks; following radiotherapy, patients received
procarbazine, lomustine (CCNU), and vincristine (PCV) for 1 year or until tumor
progressed.
Results.
Eighty-three patients were evaluable for analysis.
Seventy-four of the 83 patients (89%) received one or more courses of PCV; their
median survival was 55 weeks.
Total resection was performed in 20% (15 of 74), subtotal resection in 69% (51
of 74), and biopsy in 11% (8 of 74); reoperation (total or subtotal resection)
was performed in 28 patients (37%).
Survival was worst for those > or = 61 year old (median 35 weeks).
Fits of the Cox proportional hazards regression model showed covariates
individually predictive of improved survival were younger age (p < 0.01),
smaller log of radiation volume (p = 0.008), total or subtotal resection vs.
biopsy (p = 0.056), and higher Karnofsky performance status (p = 0.055).
A multivariate analysis showed that age (p = 0.013) and extent of initial
surgery (p = 0.003) together were predictive of a better survival with no other
variables providing additional significance.
Only 8.4% (7 of 83) of patients had clinically documented therapy-associated
neurotoxicity ("radiation necrosis").
Conclusion.
When comparable selection criteria were applied, the survival in this study is
similar to the results currently attainable with other chemoradiation
approaches.
The relative safety of accelerated fractionated radiotherapy, as used in this
study with carboplatin, enables concomitant full-dose administration of
chemotherapy or radiosensitizing agents in glioblastoma multiforme patients.
PMID:
7673023 [PubMed - indexed for MEDLINE]
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7673023&dopt=Abstract |
