Treatment > PCV

Meeting Abstract

First-line chemotherapy in non resectable low-grade astrocytomas in adults

Marc Frenay, C Lebrun, D Fontaine, V Bourg, A Ramaioli, PY Marcy, F Peyrade, JF Michiels

Centre Antoine Lacassagne, Nice, France; Hopital Pasteur, Nice, France

Objective. to postpone potential neurotoxicity of radiotherapy (RT) by using a nitroso-urea based chemotherapy (NU-CT) with or without platinium salts in symptomatic non resectable pure low-grade astrocytomas requiring treatment.

Patients. Five patients (3 males, 2 females) were diagnosed for grade II astrocytomas with stereotaxic biopsy according to WHO classification.
All patients had non resectable tumor because of location or callosal extension.
First neurological symptom was partial epileptic seizures for 4 and progressive aphasia for one of them.
All had anti-epileptic drugs (pharmacological resistance: 3/5).
Time between first symptom and biopsy was 8 months to 6 years (mean: 6 years; median: 6,5 years).

Results. Patients characteristics at time of biopsy were: mean age: 38yrs (30-53); Karnofsky score: 100%; MRI: large infiltrating hypersignal in T2 sequences without enhancement after gadolinium injection located in right temporal (2), fronto-callosal (2: 1 right, 1 left), or left parietal lobes (1); no steroid treatment.
Mean time between biopsy and NU-CT was 3 months.
Four patients received 4 to 7 cycles of PCV regimen and 1, 6 courses of fotémustine/CDDP/VP16.
In 4 cases, an improvement of neurological symptoms (control of seizures and improvement of aphasia) was observed with in 3 cases, decrease of the T2 hypersignal and mass effect on MRI.
Two patients had grade 4 haematological toxicity after the fourth course of PCV.

Conclusions. Median survival (first symptom-end of follow-up) was 6 years, one patient had clinical progression with neurological motor deficit and anaplastic transformation presumed with MRI enhancement 5 years after the end of CT.
He was given RT and deceased of brain herniation 2 months later.
In symptomatic pure low grade astrocytomas, CT could be considered as a first-line treatment and may contribute to improve neurological symptoms, allowing to postpone RT.

© Copyright 2002 American Society of Clinical Oncology