A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group study

Abstract

Sixty adult patients with incompletely excised low-grade gliomas were randomly assigned to receive radiotherapy (55 Gy over a total of 6 1/2 to 7 weeks) either alone or with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU; 100 mg/sq m every 6 weeks). Pathological review showed that six patients were ineligible for the study. Evaluation of patient age, extent of surgery, tumor grade, and performance status showed no significant differences between the treatment arms. The response rate, as judged by the disappearance or reduction in size of the tumor on computerized tomography scans, was 79% for radiation therapy alone versus 54% for irradiation plus CCNU. The median survival time was 4.45 years for all patients, with no significant difference between treatment arms (p = 0.7). For the group as a whole, patient age and performance status were the most important prognostic parameters. The majority of patients receiving chemotherapy experienced moderate hematological toxicity. This study demonstrates that CCNU chemotherapy does not improve the results of radiation therapy in the treatment of incompletely excised low-grade gliomas.

Response to postoperative radiotherapy as a prognostic factor for patients with low-grade gliomas

“…The results of this study suggest that LGGs are moderately radioresponsive tumors. These results were confirmed by other authors (17,18). Eyre et al reported an 80% rate of response to radiotherapy (17), whereas results of another study found the rate of response to radiotherapy to be 46% (18).…”

“…These results were confirmed by other authors (17,18). Eyre et al reported an 80% rate of response to radiotherapy (17), whereas results of another study found the rate of response to radiotherapy to be 46% (18). In the EORTC 22845 and EORTC 22844 studies postoperative computed tomography scans were not routinely performed, thus, the residual amount of tumor was not assessed, and the response to radiotherapy was not evaluated (4,5).…”

Survival rates in patients with low‐grade glioma after intraoperative magnetic resonance image guidance

“…To date, results from at least four clinical trials that have enrolled adult patients diagnosed with low-grade glioma have been published. 29,[32][33][34][35][36] None of those trials randomized according to surgical resection; rather, they were randomized according to the use of radiotherapy and/or chemotherapy, although it is interesting to note that, within those trials, one of the primary predictors of outcome was the extent of surgical resection. To our knowledge, no population-based effort exists that has focused exclusively on patients with low-grade gliomas; thus, the commencement of such studies in the near future are likely to generate valuable information regarding outcomes for this group of patients.…”

Apurinic Endonuclease Activity in Adult Gliomas and Time to Tumor Progression after Alkylating Agent-Based Chemotherapy and after Radiotherapy

“…The role of alkylating agents in the treatment of grade II gliomas is under active investigation. Although early studies indicated that alkylating agents provided no survival benefit (17), recent trials have shown that temozolomide can increase TTP and enhance overall survival in recurrent low-grade gliomas (18).…”