|
|
Clinical course and pathologic findings after
Gliadel and radiotherapy for newly diagnosed malignant glioma: implications for
patient management
Kleinberg LR, Weingart J, Burger P, Carson K, Grossman SA, Li K, Olivi A,
Wharam MD, Brem H
Johns Hopkins Oncology Center, Johns Hopkins University, 401
North Broadway, Baltimore, MD 21231, USA. kleinla@jhmi.edu.
Randomized trials have demonstrated Gliadel improves survival for appropriately
selected patients with newly diagnosed malignant glioma.
As only limited information is available to guide the management of patients who
have Gliadel controlled-release BCNU wafers implanted in the cranial resection
cavity prior to radiotherapy (RT), this retrospective review was conducted to
describe clinical course, toxicity, and pathologic findings after this therapy
for newly diagnosed malignant glioma.
Forty-six consecutive patients receiving Gliadel (3.8% BCNU impregnated
wafers) followed by radiotherapy for newly diagnosed malignant glioma at Johns
Hopkins Hospital from 1990 to August 1999 were identified, although one was lost
to follow up and is excluded.
Patients were evaluated for postoperative infection, pathology at reoperation,
and survival.
Twenty-eight patients received radiotherapy at Johns Hopkins and these patients
are also evaluable for toxicity experienced during and one month after
completion of RT.
The median age of all patients is 57 years.
Eighty-nine percent had glioblastoma, and median follow-up of surviving
glioblastoma patients is 16.8 (12-20) months.
Postoperative infection or need for reoperation within 30 days was uncommon
after Gliadel placement.
Full-dose radiotherapy was tolerable after Gliadel implantation.
Five patients (19%) developed neurologic symptoms during radiotherapy responding
to increased steroids and/or anticonvulsants, whereas an additional 8 of 27
(30%) developed neurologic symptoms during dexamethasone taper that responded to
increases in dexamethasone dose.
At one month after RT, 58% of patients were still on dexamethasone despite
attempted taper.
Fifteen of 45 patients, 33% underwent reoperation or biopsy for a new local
contrast-enhancing lesion.
In five of 15 (33%) the reoperation revealed necrosis or treatment effect
without active tumor.
Two of five patients with treatment/effect necrosis has a third surgery 2.9 and
3.2 months after the initial reoperation, and treatment effect/necrosis without
tumor was demonstrated in both cases.
The Kaplan-Meier median survival for all the glioblastoma patients is 12.8 (95%
CI 9.6, 15.9) months.
For glioblastoma patients under 55 years old, median survival is 15.9 (95% CI
13.5, too few events) months whereas for older patients it is 9.6 (7.7, 14.4)
months.
We conclude that Gliadel followed by full-dose standard radiotherapy is
acutely well tolerated, although, close supervision should be emphasized during
dexamethasone taper.
Median survival in excess of one year suggests that there are not complications
that result in overall premature death.
The finding of necrosis/treatment effect was noted in five of 45 (11%) of all
patients and five of 15 (33%) of those undergoing reoperation.
Therefore, the possibility of necrosis/treatment effect should be considered for
each patient with radiographic findings suspicious for local recurrence.
PMID: 15069758 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15069758
|
