ABSTRACT
OBJECTIVE: This study is aimed at evaluating the efficacy and the toxicity of a 72-hour continuous intravenous infusion of ACNU and CDDP before radiotherapy in adult patients with newly diagnosed anaplastic astrocytoma and glioblastoma. METHODS: Forty-three adult patients with a postoperative Karnofsky performance status greater than 60 were entered into this protocol without any prior treatment. Two cycles of preradiation chemotherapy were performed at 6-week intervals. Conventional radiotherapy was begun 6 weeks later. Magnetic resonance (MR) imaging studies were conducted pre- and postoperatively, and follow-up MR images at the beginning of each treatment and every three months after radiotherapy completion. Response rate, survival rate, prognostic factors and complications were evaluated. RESULTS: Among 43 patients mentioned above, twenty-one patients completed two cycles of chemotherapy. One patient showed complete remission, ten partial response, seven stable disease and three progressive disease. The median survival time was 15.9 months. Overall response rate was 22.3%. Twenty-seven showed pancytopenia, including two bleeding tendencies, one intracerebral hemorrhage resulting to death, and another two infections. Considering the prognostic factors, only a mutated p53 level of under 20%(% of tumor cells containing mutated p53) was correlated with survival prolongation. Prognostic factor of age under 45 was the only significant factor of extending the time to progression. CONCLUSION: This treatment protocol shows favorable results of preradiation chemotherapy using ACNU and CDDP.
Subject(s)
Adult , Humans , Astrocytoma , Cerebral Hemorrhage , Clinical Protocols , Drug Therapy , Follow-Up Studies , Glioblastoma , Hemorrhage , Infusions, Intravenous , Karnofsky Performance Status , Nimustine , Pancytopenia , Radiotherapy , Survival RateABSTRACT
In order to determine if there was an enhancing therapeutic effect of ACNU(1-4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride, nimustine chloride given in addition to radiotherapy, we performed a randomized clinical study of irradiation alone and combination of irradiation with ACNU in the treatment of malignant gliomas. Thirty-seven patients who were treated in our hospital from August 1990 to September 1992 were included in this study. An effect was defined as a statistically improved survival times. Radiotherpy with a total dose of 5000 to 6500 rads was applied to the whole brain and to a generous field surrounding the tumor. Patients who were assigned to receive chemotherapy were given ACNU intravenously at a dose of 1-2mg/kg. The survival rates of patients with anaplastic astrocytoma and glioblastoma multiforme at 18 months after the surgery were 0% and 37% for radiotherapy alone, and 66.7% and 40.1% for radiotherapy plus ACNU, respectively. The median survival times of patients with anaplastic astrocytoma and glioblastoma multiforme were 14 and 15 months for radiotherapy alone, and 19 and 16 months for radiotherapy plus ACNU, respectively. The survival rates of patients with malignant gliomas(anaplastic astrocytoma plus glioblastoma multiforme) at 18 months were 5.5% for radiotherapy alone and 45.4% for radiotherapy plus ACNU, and the median survival times were 15 and 16 months, respectively, Althouh the survival rate of patients with malignant gliomas at initial 6 months was much higher in radiotherapy plus ACNU than in radiotherapy alone, the differences between survival curves were not significant at the p=0.05 level. This study demonstrated that, although the use of ACNU during radiotherapy suppressed malignant gliomas more than radiotherapy alone, the survival time was not extended significantly. It is necessary to continue to search for an effective chemotherapapeutic regimen to prolong survival of patients with malignant gliomas.
Subject(s)
Humans , Astrocytoma , Brain , Drug Therapy , Glioblastoma , Glioma , Nimustine , Radiotherapy , Survival RateABSTRACT
No abstract available.
Subject(s)
Humans , Astrocytoma , Brain , Drug Therapy , Glioblastoma , Glioma , Nimustine , RadiotherapyABSTRACT
In 17 cases of glioblastoma multiforme and 3 cases of anaplastic astrocytoma, ACNU chemotherapy was performed by intravenous(10 cases) and supraophthalmic or superselective intraarterial(10 cases) injection postoperatively combined with radiation therapy. The postoperative median survival time in 17 cases of glioblastoma multiforme was 15 months(7 cases alive), and those for intravenous(8 cases) and intraarterial(9 cases) were 16.3 months(2 case alive) and 13 months(5 cases alive) respectively. 3 cases of anaplastic astrocytoma(2 cases intravenous, 1 case intraarterial) are all alive and the average postoperative follow-up period was 22.5 months. The survival rate of patients with gliobalstoma multiforme at 18 months after operation was 47.6%, and those for intravenous and intraarterial were 57.6% and 36.5%. In an analysis of performance status at the time of 3 months following surgery, there was remarkable improvement of quality of life in 70% of glioblastoma multiforme treated. In postoperative 12 months, about 50% of gliobalstoma multiforme patients could carry their normal daily life. Systemic side effects such as leukopenia and thrombocytopenia occurred little more frequently in intravenous group than intraarterial group. But more serious local neurological complication such as visual loss(1 case) and leucoencephalopathy(1 case) occurred in intraarterial group. Platelet count were decreased maximally in the fourth week after ACUN administration.