High grade gliomas. Multidisciplinar treatment with radiotherapy and concurrent carmustine after surgery

• Autores: Angel Agustín Segura Huerta, Roberto Díaz Beveridge, José Alejandro Pérez Fidalgo, Verónica Calderero Aragón, Román Amador, Gaspar Reynés Muntaner
• Localización: Revista de oncología: Publicación oficial de la Federación de Sociedades Españolas de Oncología y del Instituto Nacional de Cancerología de México, ISSN 1575-3018, Vol. 6, Nº. 4, 2004, págs. 207-211
• Idioma: inglés
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• Resumen

  • Introduction. Surgery and radiotherapy show an improvement in overall survival rates in the treatment of newly diagnosed malignant gliomas. The role of chemotherapy is uncertain. The aim of the present study was to evaluate toxicity and outcomes in patients with high-grade gliomas treated with carmustine (BCNU) concurrent with radiotherapy.

    Material and methods. A descriptive single-arm study was conducted in patients with newly diagnosed high grade glioma who, post-surgery and concurrent with radiotherapy, had BCNU (200 mg/m2) administered on day 1 every 42 days.

    Results. There were 43 patients (26 men and 17 women), median age of 54.5 years in the trial. Histology indicated glioblastoma in 36 patients (84%) and anaplastic astrocytoma in 7 patients (16%). Surgery was radical in 30 patients (70%) and non-radical in 13 (30%). Complete response (CR) was achieved in 13 patients (30%) by the conclusion of the treatment with 2 patients (5%) in partial response (PR). Progressive disease (PD) was recorded in 26 patients (60%). With a median follow-up 11 months, 8 patients (19%) are alive and disease free, 5 (12%) are alive with disease and 30 (70%) have expired. With a median time to progression of 7 months, median survival is 12 months and at 6 months the disease free survival is 53%. With 36 months of follow-up, the potential rate of long-term survival is 15% (10% in patients with glioblastoma). Toxicity grades 3­4 observed were: 16% leukopenia, 12% thrombopenia, 5% emesis and anaemia.

    Conclusions. BCNU concurrent with radiotherapy is a well-tolerated and feasible regimen. Patients with radical surgery remain progression-free at the end of treatment in a 50% of cases. In cases in which surgery was non-radical, 2 partial responses were achieved (15%). We also obtained a satisfactory time-to-progression and overall survival.