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State-of-the-art treatment of high-grade brain
tumors
Brandes AA
Medical Oncology Department, Azienda Ospedale-Universita, Padova,
Italy.
The incidence of primary brain tumors has rapidly increased in recent
years.
The current standard of care for patients with high-grade malignant glioma is
resection followed by radiotherapy.
However, the use of adjuvant chemotherapy and the standard of care at first
relapse are still under debate for patients with glioblastoma multiforme and
anaplastic astrocytoma.
Meta-analyses have suggested that adjuvant chemotherapy, specifically with
nitrosourea-based regimens, is associated with improved survival.
However, no randomized, controlled trial has shown a clear advantage for
adjuvant chemotherapy in these patients.
Cumulative toxicity associated with both radiotherapy and chemotherapy, as well
as resistance to nitrosourea-based regimens related to exposure in the adjuvant
setting, prevent the use of radiotherapy and nitrosourea-based regimens at first
relapse.
The combination of procarbazine, carmustine, and vincristine (PCV) has shown
activity at first relapse in patients who have not received adjuvant
chemotherapy.
Temozolomide (Temodar [US], Temodal [international]; Schering-Plough
Corporation, Kenilworth, NJ) has shown activity at both first and second relapse
in patients who have received prior nitrosourea-based regimens.
The better safety profile of temozolomide suggests that it may be preferred to
PCV for treatment of patients with recurrent high-grade malignant glioma.
Additional randomized, controlled trials are needed to fully define the best
option for first-line chemotherapy in both the adjuvant and recurrent settings
in patients with high-grade malignant glioma.
PMID: 14765377 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14765377
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