Pre-radiation chemotherapy in glioma patients with poor prognostic factors

Watne, Kjell; Nome, Ole; Hager, Bjarne; Hirschberg, Henry

doi:10.1007/bf00172479

Cited by 10 publications

(4 citation statements)

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“…121 Recent reports suggest a benefit in using chemotherapy prior to RT, particularly in oligodendrogliomas. 122 Newer agents such as the topoisomerase I inhibitors topotecan and irinotecan (CPT-11) are also under investigation as preradiation chemotherapy for glioblastomas. Preradiation chemotherapy can be used for palliation in patients with low performance status.…”

Section: Side Effects Of Radiation Therapymentioning

confidence: 99%

“…Preradiation chemotherapy can be used for palliation in patients with low performance status. 122 The most common side effect of chemotherapy is myelosuppression, which may require blood transfusions or the use of colony-stimulating factors. Myelosuppression from chemotherapy occurs earlier in the course of treatment in older patients.…”

Section: Side Effects Of Radiation Therapymentioning

confidence: 99%

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Brain Tumors in the Older Person

Flowers

2000

Cancer Control

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Section: Side Effects Of Radiation Therapymentioning

confidence: 99%

Section: Side Effects Of Radiation Therapymentioning

confidence: 99%

Brain Tumors in the Older Person

Flowers

2000

Cancer Control

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“…The concept of preirradiation chemotherapy for glioblastoma is not new6, 7 but it has not been followed rigorously and improved despite some promising results, (e.g., with intraarterial cisplatin) 8. More recently, lomustine, PCV,9 taxol,10 and temozolomide11 have been evaluated as a first‐line therapy for glioblastoma.…”

Section: Discussionmentioning

confidence: 99%

Preirradiation gemcitabine chemotherapy for newly diagnosed glioblastoma

Weller

Streffer

Wick

et al. 2001

Cancer

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BACKGROUND The median survival for patients with glioblastoma is reported to be 12 months. To improve the outcome for glioblastoma patients, the authors evaluated the therapeutic efficacy of preirradiation gemcitabine chemotherapy followed by standard radiotherapy. METHODS Twenty‐one patients with newly diagnosed glioblastoma were enrolled in a prospective unicenter trial of preirradiation gemcitabine chemotherapy. Chemotherapy included up to 4 monthly cycles of intravenous gemcitabine (Day 1, Day 8, and Day 15; 1000 mg/m2). Involved field radiotherapy was given after chemotherapy or earlier in the case of disease progression or gemcitabine intolerance. RESULTS With gemcitabine chemotherapy alone, there was a median progression free survival of 11 weeks and a progression free survival rate at 4 months of 24%. In 18 of 21 patients who subsequently received a full course of radiotherapy, the median progression free survival from the time of diagnosis was 8 months and the progression free survival rate at 12 months was 17% (3 of 18 patients). The median overall survival was 11 months. There was no specific treatment‐related neurotoxicity reported. Neither age nor extent of residual postoperative tumor predicted the duration of progression free survival in patients treated with gemcitabine chemotherapy alone or in those treated with gemcitabine plus radiotherapy. CONCLUSIONS Gemcitabine followed by radiotherapy is a safe regimen for patients with newly diagnosed glioblastoma but the gemcitabine schedule used in the current study did not appear to confer any survival advantage compared with standard involved field radiotherapy alone. Cancer 2001;91:423–7. © 2001 American Cancer Society.

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“…More patients with glioblastoma and anaplastic astrocytoma might have responded had we delayed radiation another eight weeks and given a second cycle of PCV (traditionally response to chemotherapy is assessed after two cycles), but undoubtedly more would have progressed. Watne et al 14 delayed radiation and treated 19 patients with glioblastoma with two cycles of PCV, 48% progressed within 16 weeks of diagnosis. Due to delayed myelosuppression and long cycle times it may take 12-18 weeks to deliver two cycles of PCV chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Pre-radiation Chemotherapy for Malignant Glioma in Adults

Kirby

Macdonald

Fisher

et al. 1996

Can. j. neurol. sci.

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Purpose: To review our experience with pre-radiation chemotherapy for malignant glioma. Methods: Consecutive adults with newly diagnosed glioblastoma, anaplastic astrocytoma, anaplastic oligodendroglioma and anaplastic mixed glioma with a Karnofsky Performance Score of 60 or greater were treated with one cycle of procarbazine, lomustine and vincristine or lomustine alone, prior to radiation. Computed tomographic scans were obtained soon after surgery, eight weeks later, after radiation, and at regular intervals thereafter. The effects of chemotherapy and subsequent radiation and durations of tumor control and survival were assessed in this single arm, single center, prospective trial. Results: Thirty-seven patients started chemotherapy, 36 were rescanned eight weeks after diagnosis. Five patients (16%) responded to the first cycle of chemotherapy, three had glioblastoma and two anaplastic oligodendroglioma. Seven (19%) progressed during the first cycle, 6 had glioblastoma; with the addition of radiation one progressive case responded, three stabilized, and three continued to progress. Median times to progression and median durations of survival were 26 weeks and 60 weeks for the entire group, 24 weeks and 44 weeks for glioblastoma, and greater than 104 weeks for anaplastic astrocytoma. Conclusions: Most patients with glioblastoma do not respond to one cycle of nitrosourea-based chemotherapy given prior to radiation, but patients with anaplastic oligodendroglioma sometimes do. Patients with anaplastic astrocytoma may not respond to one cycle of chemotherapy, but often respond to subsequent radiation. Judging by survival results, radiation can be delayed eight weeks without appearing to compromise patient outcome. Implications: Pre-radiation chemotherapy with newer agents can be evaluated more fully in the future knowing that brief delays in radiation are unlikely to yield substantially inferior results. RESUME: Chimiotherapie suivie de radiotherapie dans les gliomes malins chez I'adulte. But: Revoir notre experience avec la chimiotherapie prdirradiation dans les gliomes malins. MSthodes: Des adultes se pr6sentant cons£cutivement avec un nouveau diagnostic de glioblastoma d'astrocytome anaplasique, d'oligodendrogliome anaplasique et de gliome mixte anaplasique, avec un score de fonctionnement a l'6chelle de Karnofsky de 60 ou plus, ont 6l6 trails avec un cycle de procarbazine, CCNU (lomustine) et vincristine [PCV], ou CCNU seul, avant la radiotherapie. Un CT scan a &l6 fait tot apres la chirurgie, huit semaines plus tard, apres la radiotherapie, et a intervalles rgguliers par la suite. Les effets de la chimiotherapie et de la radiothfirapie subsequente, et la duree de controle de la tumeur et de la survie ont 6l6 evalues dans cette etude prospective d'un groupe unique, dans un seul centre. Resultats: Trente-sept patients ont commence la chimiotherapie, 36 ont subi un deuxieme scan huit semaines apres le diagnostic. Cinq patients (16%) ont repondu au premier cycle de chimiotherapie, dont trois qui present...

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Pre-radiation chemotherapy in glioma patients with poor prognostic factors

Cited by 10 publications

References 12 publications

Brain Tumors in the Older Person

Brain Tumors in the Older Person

Preirradiation gemcitabine chemotherapy for newly diagnosed glioblastoma

Pre-radiation Chemotherapy for Malignant Glioma in Adults

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