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Procarbazine, Lomustine, and Vincristine (PCV) Chemotherapy for Anaplastic
Astrocytoma: A Retrospective Review of Radiation Therapy Oncology Group
Protocols Comparing Survival With Carmustine or PCV Adjuvant Chemotherapy
Michael D. Prados, Charles Scott, Walter
J. Curran, Jr, Diana F. Nelson, Steve Leibel, Simon
Kramer
From the Department of Neurosurgery, University of
California–San Francisco, San Francisco, CA..
Address reprint requests to Michael Prados, MD, University of
California–San Francisco, Box 0372, San Francisco, CA 94143-0372; email
pradosm@neuro.ucsf.edu.
Purpose. To determine any differences in
outcome for patients with anaplastic astrocytoma (AA) treated with
adjuvant carmustine (BCNU) versus procarbazine, lomustine, and
vincristine (PCV) chemotherapy.
Materials and Methods. The Radiation Therapy Oncology Group (RTOG)
database was reviewed for patients with newly diagnosed AA treated
according to protocols that included either BCNU or PCV adjuvant
chemotherapy.
All patients were treated with radiation therapy.
The outcome analysis included overall survival, taking into account
patient age, extent of resection, Karnofsky performance status (KPS),
and treatment group (BCNU v PCV).
Stratified and nonstratified Cox proportional hazards models were
used, as well as an analysis using matched cases between the groups.
Results. A total of 257 patients were treated with BCNU according
to RTOG protocols 70-18, 83-02, and 90-06; 175 patients were treated
with PCV according to RTOG protocol 94-04.
All pretreatment characteristics except KPS were well balanced by
treatment group; 61% of the BCNU group had a KPS of 90 to 100
compared with 73% of the PCV group (P = .0075).
No statistically significant difference in survival was observed in
any age group or by KPS or extent of surgery.
The stratified analysis also showed no trends for improved survival
by treatment group (P = .40).
The Cox model identified only age, KPS, and extent of surgery as
important variables influencing survival, not treatment group.
Matching cases between groups using age, KPS, and surgery resulted in
133 matched pairs.
No difference in survival was observed (P = .41).
In a Cox model in which each matched pair is a strata, there was no
difference between groups (P = .20).
Conclusion. Using this retrospective analysis, there does not seem
to be any survival benefit to PCV chemotherapy.
Future phase III studies for patients with AA may need to consider
whether BCNU or PCV is used in the control arm.
© 1999 American Society for Clinical Oncology
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