Treatment > Radiation-Enhancing Agents

Meeting Abstract

Radiosurgery (RS) plus estramustine in the treatment of patients (pts) with malignant primary brain tumors (MBT)

Howard Landy, Arnold Markoe, Priscilla Potter, Angela Marini, Niramol Savaraj, Isildinha Reis, Medhi Wangpaichitr, Lynn Feun

University of Miami, Miami, FL; V.A. Medical Center, Miami, FL

Rationale. 1) Malignant gliomas express estramustine binding proteins(EBP). EBP is important for estramustine antitumor activity and tissue accumulation.
2) Cytotoxic concentrations of estramustine metabolites may be found in MBT after oral administration.
3) Estramustine has antitumor activity in both in vitro and in-vivo glioma models.
4) Combination of estramustine with radiation has either additive or synergistic effects in human glioma cells.

Method. Estramustine was given orally at 16 mg/kg per day, starting 3 days prior to gamma knife RS followed by cranial RT, and continued until end of RS/RT treatment.
For newly diagnosed pts with MBT, RT started within 1 week of RS.
RT consisted of total 72 Gy, 1.2 Gy bid, 60 fractions, over 6 weeks, first 57.6 Gy/48 fractions, using postoperative CT/MRI contrast brain scan + 2 cm margin. Pts with recurrent MBT received RS but not RT.

Results. 24 pts with MBT were entered into the study: 15 newly diagnosed glioblastoma (GBM) pts, 5 pts with recurrent GBM, 1 newly diagnosed anaplastic astrocytoma (AA), 1 anaplastic oligodendroglioma (OA) and 2 recurrent AA.
Median age for GBM was 57.
Median survival for newly diagnosed GBM was 14.5 months (range 1 + to 38+ months).
For pts with recurrent GBM survival was 9, 12, 15, and 24+ months, for recurrent AA 3+ and 42+ months, and for newly diagnosed AA 20 months and anaplastic OA 40+ months.
Toxicity included grade 1 nausea, and thrombophlebitis (3 pts).

Conclusion. Preliminary data suggest that estramustine may have potential as a radiosensitizer for pts with MBT and further accrual to this study is continuing.

© Copyright 2002 American Society of Clinical Oncology