Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Levin VA, Prados MR, Wara WM, Davis RL, Gutin PH, Phillips TL, Lamborn K, Wilson CB. Radiation therapy and bromodeoxyuridine chemotherapy followed by procarbazine, lomustine, and vincristine for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys 1995;32:75-83. [PMID: 7721642 DOI: 10.1016/0360-3016(94)00488-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

For:	Levin VA, Prados MR, Wara WM, Davis RL, Gutin PH, Phillips TL, Lamborn K, Wilson CB. Radiation therapy and bromodeoxyuridine chemotherapy followed by procarbazine, lomustine, and vincristine for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys 1995;32:75-83. [PMID: 7721642 DOI: 10.1016/0360-3016(94)00488-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

Number

Cited by Other Article(s)

Beg U, Snyder BM, Madhani SI, Hamidi N, Padmanaban V, Tuanquin LC, Kruser TJ, Connor J, Mansouri A. Current Landscape and Future Prospects of Radiation Sensitizers for Malignant Brain Tumors: A Systematic Review. World Neurosurg 2021;151:e839-e856. [PMID: 33974987 DOI: 10.1016/j.wneu.2021.04.134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/21/2022]

Hoffman RM, Kokkinakis DM, Frenkel EP. Total Methionine Restriction Treatment of Cancer. Methods Mol Biol 2019;1866:163-171. [PMID: 30725415 DOI: 10.1007/978-1-4939-8796-2_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]

Kargar S, Khoei S, Khoee S, Shirvalilou S, Mahdavi SR. Evaluation of the combined effect of NIR laser and ionizing radiation on cellular damages induced by IUdR-loaded PLGA-coated Nano-graphene oxide. Photodiagnosis Photodyn Ther 2017;21:91-97. [PMID: 29155336 DOI: 10.1016/j.pdpdt.2017.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/04/2017] [Accepted: 11/15/2017] [Indexed: 12/23/2022]

Solimando DA, Waddell JA. Procarbazine, Lomustine, and Vincristine (PCV) Regimen for Central Nervous System Tumors. Hosp Pharm 2017;52:98-104. [PMID: 28321136 DOI: 10.1310/hpj5202-98] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]

Levin VA, Tonge PJ, Gallo JM, Birtwistle MR, Dar AC, Iavarone A, Paddison PJ, Heffron TP, Elmquist WF, Lachowicz JE, Johnson TW, White FM, Sul J, Smith QR, Shen W, Sarkaria JN, Samala R, Wen PY, Berry DA, Petter RC. CNS Anticancer Drug Discovery and Development Conference White Paper. Neuro Oncol 2016;17 Suppl 6:vi1-26. [PMID: 26403167 DOI: 10.1093/neuonc/nov169] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open

Affiliation(s)

Victor A Levin Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Peter J Tonge Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
James M Gallo Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Marc R Birtwistle Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Arvin C Dar Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Antonio Iavarone Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Patrick J Paddison Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Timothy P Heffron Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
William F Elmquist Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Jean E Lachowicz Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Ted W Johnson Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Forest M White Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Joohee Sul Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Quentin R Smith Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Wang Shen Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Jann N Sarkaria Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Ramakrishna Samala Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Patrick Y Wen Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Donald A Berry Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)
Russell C Petter Kaiser Permanente, Redwood City, California, USA (V.A.L.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (V.A.L.); University of California, San Francisco, CA, USA (V.A.L.); SUNY Stony Brook University, Stony Brook, NY, USA (P.J.T.); Icahn School of Medicine at Mount Sinai, New York, NY, USA (J.M.G., M.R.B., A.C.D.); Columbia University Institute for Cancer Genetics, New York, NY, USA (A.I.); Fred Hutchinson Cancer Research Center, Seattle, WA, USA (P.J.P.); Genentech, Inc., South San Francisco, CA, USA (T.P.H.); University of Minnesota School of Pharmacy, Minneapolis, MN, USA (W.F.E.); Angiochem, Inc., Montreal, Quebec, Canada (J.E.L.); Pfizer Oncology, San Diego, CA, USA (T.W.J.); Massachusetts Institute of Technology, Cambridge, MA, USA (F.M.W.); US Food and Drug Administration, Silver Spring, MD, USA (J.S.); Texas Tech University School of Pharmacy, Amarillo, TX, USA (Q.R.S., R.S.); NewGen Therapeutics, Inc., Menlo Park, CA, USA (W.S.); Mayo Clinic, Rochester, MN, USA (J.N.S.); Dana-Farber Cancer Institute, Boston, MA, USA (P.Y.W.); University of Texas MD Anderson Cancer Center, Houston, TX, USA (D.A.B.); Celgene Avilomics Research, Bedford, MA, USA (R.C.P.)

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Bampoe J, Bernstein M. Advances in radiotherapy of brain tumors: radiobiology versus reality. J Clin Neurosci 2012;5:5-14. [PMID: 18644279 DOI: 10.1016/s0967-5868(98)90193-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/1996] [Accepted: 04/17/1997] [Indexed: 10/26/2022]

Blondin NA, Becker KP. Anaplastic gliomas: radiation, chemotherapy, or both? Hematol Oncol Clin North Am 2012;26:811-23. [PMID: 22794285 DOI: 10.1016/j.hoc.2012.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]

Morgenroth A, Vogg AT, Mottaghy FM, Schmaljohann J. Targeted endoradiotherapy using nucleotides. Methods 2011;55:203-14. [PMID: 21782950 DOI: 10.1016/j.ymeth.2011.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/24/2011] [Accepted: 06/28/2011] [Indexed: 11/15/2022] Open

Kimbrough A, Kwon B, Eckel LA, Houpt TA. Systemic 5-bromo-2-deoxyuridine induces conditioned flavor aversion and c-Fos in the visceral neuraxis. Learn Mem 2011;18:292-5. [PMID: 21498563 DOI: 10.1101/lm.2176611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Butowski N, Lamborn KR, Lee BL, Prados MD, Cloughesy T, DeAngelis LM, Abrey L, Fink K, Lieberman F, Mehta M, Ian Robins H, Junck L, Salazar AM, Chang SM. A North American brain tumor consortium phase II study of poly-ICLC for adult patients with recurrent anaplastic gliomas. J Neurooncol 2009;91:183-9. [PMID: 18850068 PMCID: PMC3104130 DOI: 10.1007/s11060-008-9705-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/15/2008] [Indexed: 11/24/2022]

Clarke JW, Chang EL, Levin VA, Mayr NA, Hong E, Cavaliere R, Lo SS. Optimizing radiotherapy schedules for elderly glioblastoma multiforme patients. Expert Rev Anticancer Ther 2008;8:733-41. [PMID: 18471046 DOI: 10.1586/14737140.8.5.733] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Coucke PA, Cottin E, Decosterd LA. Simultaneous alteration of de novo and salvage pathway to the deoxynucleoside triphosphate pool by (E)-2'-deoxy-(fluoromethylene)cytidine (FMdC) and zidovudine (AZT) results in increased radiosensitivity in vitro. Acta Oncol 2007;46:612-20. [PMID: 17562437 DOI: 10.1080/02841860601137389] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]

Pulkkanen KJ, Yla-Herttuala S. Gene therapy for malignant glioma: current clinical status. Mol Ther 2006;12:585-98. [PMID: 16095972 DOI: 10.1016/j.ymthe.2005.07.357] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 07/06/2005] [Accepted: 07/06/2005] [Indexed: 12/24/2022] Open

Barai S, Bandopadhayaya GP, Pant GS, Haloi AK, Malhotra A, Dhanpathi H. Thallium-201 versus Tc99m-glucoheptonate SPECT for evaluation of recurrent brain tumours: a within-subject comparison with pathological correlation. J Clin Neurosci 2006;12:27-31. [PMID: 16568553 DOI: 10.1016/j.jocn.2004.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Roullin VG, Mege M, Lemaire L, Cueyssac JP, Venier-Julienne MC, Menei P, Gamelin E, Benoit JP. Influence of 5-fluorouracil-loaded microsphere formulation on efficient rat glioma radiosensitization. Pharm Res 2005;21:1558-63. [PMID: 15497679 DOI: 10.1023/b:pham.0000041448.22771.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]

Watanabe T, Katayama Y, Yoshino A, Fukaya C, Yamamoto T. Human interferon beta, nimustine hydrochloride, and radiation therapy in the treatment of newly diagnosed malignant astrocytomas. J Neurooncol 2005;72:57-62. [PMID: 15803376 DOI: 10.1007/s11060-004-2160-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]

Prados MD, Seiferheld W, Sandler HM, Buckner JC, Phillips T, Schultz C, Urtasun R, Davis R, Gutin P, Cascino TL, Greenberg HS, Curran WJ. Phase III randomized study of radiotherapy plus procarbazine, lomustine, and vincristine with or without BUdR for treatment of anaplastic astrocytoma: final report of RTOG 9404. Int J Radiat Oncol Biol Phys 2004;58:1147-52. [PMID: 15001257 DOI: 10.1016/j.ijrobp.2003.08.024] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2002] [Revised: 08/14/2003] [Accepted: 08/18/2003] [Indexed: 10/26/2022]

Abstract

PURPOSE

This study was an open-label, randomized Phase III trial in newly diagnosed patients with anaplastic glioma other than glioblastoma multiforme comparing external beam radiotherapy (EBRT) plus adjuvant procarbazine, cyclohexylchloroethylnitrosurea (lomustine), and vincristine (PCV) chemotherapy with or without bromodeoxyuridine (BUdR) given as a 96-h infusion each week of RT.

METHODS AND MATERIALS

Only patients 18 years or older with newly diagnosed anaplastic glioma were eligible. A central pathology review was accomplished for most patients, but was not mandated before registration. The study had initially opened as a Northern California Oncology Group trial in 1991, becoming an Intergroup Radiation Therapy Oncology Group (RTOG), Southwestern Oncology Group and the North Central Cancer Treatment Group study in July 1994. A total accrual of 293 patients was planned for the sample size, using survival as the primary end point. The experimental arm (RT/BUdR + PCV) was to be compared with the control arm (RT + PCV) using a one-sided alpha = 0.05, with a power of 85% for detecting an increase in median survival from 160 to 240 weeks, assuming a 3-year follow-up after enrollment completion.

RESULTS

Between July 1994 and August 1996, 134 patients were randomized to EBRT + PCV (non-BUdR patients) and 134 to EBRT/BUdR + PCV (BUdR patients). The study was closed before the full-anticipated accrual on the basis of an interim analysis that predicted no survival benefit for the BUdR arm. Of the 268 patients, 41 and 37, respectively, were ineligible or canceled primarily on the basis of the central pathology review findings. Thus, 93 patients and 97 patients were eligible/analyzable in the non-BUdR and BUdR arms, respectively. Patient characteristics were well balanced in both arms, with most <50 years old and in the RTOG recursive partitioning analysis (RPA) Class I category. The minimal potential follow-up was 4.6 years. The median survival for non-BUdR patients was 4.1 years compared with 4.6 years for the BUdR patients (p = 0.61). The 4-year overall survival rate was 51% in both arms. For RPA Class I patients (the best prognostic class), the median survival had not been reached for non-BUdR patients (4-year survival rate 61%) and was 5.6 years for BUdR patients (4-year survival rate 64%; p = 0.91). Each arm was also compared with the RTOG historical database for RPA Class I patients with no statistically significant difference found in overall survival (BUdR vs. historical, p = 0.31 and non-BUdR vs. historical, p = 0.48). Grade 4 toxicity occurred in 15 and 17 patients in the non-BUdR and BUdR arms, respectively, with one treatment-related death in the BUdR group.

CONCLUSION

No survival advantage was noted by adding BUdR to EBRT and PCV in this patient population

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Chang EL, Lo S. Diagnosis and management of central nervous system metastases from breast cancer. Oncologist 2004;8:398-410. [PMID: 14530493 DOI: 10.1634/theoncologist.8-5-398] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open

Li Y, Owusu A, Lehnert S. Treatment of intracranial rat glioma model with implant of radiosensitizer and biomodulator drug combined with external beam radiotherapy. Int J Radiat Oncol Biol Phys 2004;58:519-27. [PMID: 14751523 DOI: 10.1016/j.ijrobp.2003.09.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]

Chang EL, Yi W, Allen PK, Levin VA, Sawaya RE, Maor MH. Hypofractionated radiotherapy for elderly or younger low-performance status glioblastoma patients: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 2003;56:519-28. [PMID: 12738329 DOI: 10.1016/s0360-3016(02)04522-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Castro MG, Cowen R, Williamson IK, David A, Jimenez-Dalmaroni MJ, Yuan X, Bigliari A, Williams JC, Hu J, Lowenstein PR. Current and future strategies for the treatment of malignant brain tumors. Pharmacol Ther 2003;98:71-108. [PMID: 12667889 DOI: 10.1016/s0163-7258(03)00014-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Abstract

Glioblastoma (GB) is the most common subtype of primary brain tumor in adults. These tumors are highly invasive, very aggressive, and often infiltrate critical neurological areas within the brain. The mean survival time after diagnosis of GB has remained unchanged during the last few decades, in spite of advances in surgical techniques, radiotherapy, and also chemotherapy; patients' survival ranges from 9 to 12 months after initial diagnosis. In the same time frame, with our increasing understanding and knowledge of the physiopathology of several cancers, meaningful advances have been made in the treatment and control of several cancers, such as breast, prostate, and hematopoietic malignancies. Although a number of the genetic lesions present in GB have been elucidated and our understanding of the progressions of this cancer has increased dramatically over the last few years, it has not yet been possible to harness this information towards developing effective cures. In this review, we will focus on the classical ways in which GB is currently being treated, and will introduce a novel therapeutic modality, i.e., gene therapy, which we believe will be used in combination with classical treatment strategies to prolong the life-span of patients and to ultimately be able to control and/or cure these brain tumors. We will discuss the use of several vector systems that are needed to introduce the therapeutic genes within either the tumor mass, if these are not resectable, or the tumor bed, after successful tumor resection. We also discuss different therapeutic modalities that could be exploited using gene therapy, i.e., conditional cytotoxic approach, direct cytotoxicity, immunotherapy, inhibition of angiogenesis, and the use of pro-apoptotic genes. The advantages and disadvantages of each of the current vector systems available to transfer genes into the CNS are also discussed. With the advances in molecular techniques, both towards the elucidation of the physiopathology of GB and the development of novel, more efficient and less toxic vectors to deliver putative therapeutic genes into the CNS, it should be possible to develop new rationale and effective therapeutic approaches to treat this devastating cancer.

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Piribauer M, Fazeny-Dörner B, Rössler K, Ungersböck K, Czech T, Killer M, Dieckmann K, Birner P, Prayer D, Hainfellner J, Muhm M, Marosi C. Feasibility and toxicity of CCNU therapy in elderly patients with glioblastoma multiforme. Anticancer Drugs 2003;14:137-43. [PMID: 12569300 DOI: 10.1097/00001813-200302000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]

Kunschner LJ, Fine H, Hess K, Jaeckle K, Kyritsis AP, Yung WKA. CI-980 for the treatment of recurrent or progressive malignant gliomas: national central nervous system consortium phase I-II evaluation of CI-980. Cancer Invest 2002;20:948-54. [PMID: 12449727 DOI: 10.1081/cnv-120005910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]

Gilles FH, Leviton A, Tavaré CJ, Adelman L, Rorke LB, Sobel EL, Hedley-Whyte ET, Davis RL. Clinical and survival covariates of eight classes of childhood supratentorial neuroglial tumors. Cancer 2002;95:1302-10. [PMID: 12216099 DOI: 10.1002/cncr.10815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Akman F, Cooper RA, Sen M, Tanriver Y, Kentli S. Validation of the Medical Research Council and a newly developed prognostic index in patients with malignant glioma: how useful are prognostic indices in routine clinical practice? J Neurooncol 2002;59:39-47. [PMID: 12222837 DOI: 10.1023/a:1016353614525] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]

Abstract

Although different prognostic indices for malignant gliomas have been developed, their validity outside of clinical trials has not been widely tested. The aim of this study was to determine whether the Medical Research Council (MRC) brain tumour prognostic index was able to stratify patients for survival managed in routine practice, and secondly to compare the results with our newly developed prognostic score which included tumour grade and only 3 prognostic groups. The MRC and the new prognostic index were calculated for a group of 119 adult patients with malignant glioma managed by surgical resection/biopsy and post-operative radiotherapy. For the MRC and new score, 6 and 3 prognostic groups were defined, respectively. For all patients median survival was 11 (2-66) months. The overall survival rate at 12 and 24 months were 43% and 18%, respectively. The MRC median and two-year survival rates were 14 months and 26% for a score of 1-10, 14 months and 27% for a score of 11-15, 13 months and 22% for a score of 16-20, 8 months and 10% for a score of 21-25, 8 months and 0% for those scoring 26-33. There was only one patient in the 34-38 group. For the new prognostic index, median and two-year survival rates were respectively 16 and 26%; 12 and 23%; 8 and 7% for the good, intermediate and poor prognostic groups. Both indices were significant factors for survival in univariate analysis (MRC index, p = 0.0089, new index p = 0.0002), but not in multivariate analysis. Both the MRC and our newly devised prognostic score were able to separate patients into good and poor prognostic groups, which may aid in treatment decisions, although there was less differentiation between the MRC groups especially over the first year. Both scores use routinely available factors. However, inclusion of tumour grade in the new score may be an advantage over the MRC index.

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Rao RD, Thomé SD, O'Fallon J, Earle JD, Dinapoli RP, Buckner JC. Safety of thrice-daily hyperfractionated radiation and BCNU for high-grade gliomas. Int J Radiat Oncol Biol Phys 2002;53:376-84. [PMID: 12023142 DOI: 10.1016/s0360-3016(02)02731-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]

Levin VA, Yung WKA, Bruner J, Kyritsis A, Leeds N, Gleason MJ, Hess KR, Meyers CA, Ictech SA, Chang E, Maor MH. Phase II study of accelerated fractionation radiation therapy with carboplatin followed by PCV chemotherapy for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys 2002;53:58-66. [PMID: 12007942 DOI: 10.1016/s0360-3016(01)02819-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]

Abstract

PURPOSE

To conduct a Phase II one-arm study to evaluate the long-term efficacy and safety of accelerated fractionated radiotherapy combined with i.v. carboplatin for patients with previously untreated anaplastic gliomas.

METHODS AND MATERIALS

Between 1988 and 1992, 90 patients received 1.9-2.0-Gy radiation 3 times a day with 2-h infusions of 33 g/m(2) carboplatin for two 5-day cycles separated by 2 weeks. After radiotherapy, patients received procarbazine, lomustine (CCNU), and vincristine (PCV) for 1 year or until the tumor progressed.

RESULTS

Ninety patients were evaluable for analysis. Histologically, 69 had anaplastic astrocytoma; 14, anaplastic oligoastrocytoma; and 7, anaplastic oligodendroglioma. Gross total resection was performed in 20 (22%), subtotal resection in 45 (50%), and biopsy in 25 (28%); reoperation (total or subtotal resection) was performed in 50 (56%) patients. A multivariate analysis showed that a younger age (p = 0.026), Karnofsky performance score (KPS; p = 0.009), and brain necrosis (p = 0.0002) were predictive of a better survival. Results from analysis of extent of surgery (biopsy, subtotal resection, gross total resection) approached significance (p = 0.058). Radiation dose, irradiated tumor volume, and techniques used (boost and fields) were not significant variables. The median survival (MS) of all anaplastic glioma patients was 28.1 months; for anaplastic astrocytoma patients, MS was 28.7 months and 40.8 months for the combined anaplastic oligodendroglioma/oligoastrocytoma patients. Long-term survival occurred in 25% of anaplastic glioma patients who were alive 8.6 years after treatment was initiated. Treatment-induced necrosis was documented by surgery or autopsy in 19 (21%) patients; 21 (23%) had a mixed pattern of necrosis and tumor; and an additional 13 (14%) patients who did not have surgical or autopsy demonstration of predominant radiation necrosis had magnetic resonance imaging (MRI) evidence of radiation necrosis. Serious clinical neurologic deterioration and/or dementia requiring full-time caregiver attention were observed in 9 (10%) patients.

CONCLUSION

When comparable selection criteria are applied, the rate of MS in this study is inferior to results attainable with current radiation and chemotherapy approaches, although the rates of long-term survival are comparable. Theoretically, patients failing therapy and dying earlier than anticipated may be because of excessive central nervous system (CNS) toxicity resulting from the combination of accelerated fractionated irradiation, intensive carboplatin chemotherapy before each radiation fraction, and postirradiation PCV chemotherapy. On the other hand, patients with treatment-induced necrosis survived significantly longer than patients who did not demonstrate MRI or histologic evidence of necrosis (MS, 106 months vs. 18-33 months).

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Murphy C, Pickles T, Knowling M, Thiesse B. Concurrent modified PCV chemotherapy and radiotherapy in newly diagnosed grade IV astrocytoma. J Neurooncol 2002;57:215-20. [PMID: 12125984 DOI: 10.1023/a:1015797713149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]

Sugiyama K, Kurisu K, Arita K, Taniguchi E, Okamura T, Itoh Y, Yamasaki F, Kajiwara Y, Ueda H, Sakai A. Myelodysplastic syndrome following therapy for brain tumor--two case reports. Neurol Med Chir (Tokyo) 2002;42:170-4. [PMID: 12013670 DOI: 10.2176/nmc.42.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open

Jennings MT, Iyengar S. Pharmacotherapy of malignant astrocytomas of children and adults: current strategies and future trends. CNS Drugs 2002;15:719-43. [PMID: 11580310 DOI: 10.2165/00023210-200115090-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]

Abstract

This article reviews the conceptual progression in the pharmacological therapy of malignant astrocytoma (MA) over the past decade, and its future trends. It is a selective rather than an exhaustive inventory of literature citations. The experience of the Brain Tumour Cooperative Group (BTCG) and earlier phase III trials are summarised to place subsequent phase II and I studies of single and combination agent chemotherapy in perspective. The BTCG experience of the 1970s to 1980s may be summarised to indicate that external beam radiotherapy (EBRT) is therapeutic, although not curative, and not further improved upon by altering fractionation schedules, or the addition of radioenhancers. Whole brain and reduced whole brain EBRT with focal boost were comparable regimens. Nitrosourea-based, adjuvant chemotherapy provided a modest improvement in survival among adult patients, which was comparable with that of other single drugs or multidrug regimes. The multiagent schedules, however, had a correspondingly higher toxicity rate. Intra-arterial administration was associated with significant risk, which conferred no therapeutic advantage. The trend of the past decade has been towards multiagent chemotherapy although its benefit cannot be predicted from the classic prognostic factors. Published experience with investigational trials utilising myeloablative chemotherapy with autologous bone marrow or peripheral blood stem cell haemopoietic support, drug delivery enhancement methods and radiosensitisers is critically reviewed. None of these approaches have achieved wide-spread acceptance in the treatment of adult patients with MA. Greater attention is placed on recent 'chemoradiotherapy' trials, which attempt to integrate and maximise the cytoreductive potential of both modalities. This approach holds promise as an effective means to delay or overcome the evolution of tumour resistance, which is probably one of the dominant determinants of prognosis. However, the efficacy of this approach remains unproven. New chemotherapeutic agents as well as biological response modifiers, protein kinase inhibitors, angiogenesis inhibitors and gene therapy are also discussed; their role in the therapeutic armamentarium has not been defined.

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Berry SE, Kinsella TJ. Targeting DNA mismatch repair for radiosensitization. Semin Radiat Oncol 2001;11:300-15. [PMID: 11677655 DOI: 10.1053/s1053-4296(01)80067-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]

Abstract

Postreplicational mismatch repair (MMR) proteins are capable of recognizing and processing not only single base-pair mismatches and insertion-deletion loops (IDLs) that occur during DNA replication, but also adducts in DNA resulting from treatment with cancer chemotherapy agents. These include widely varying types of DNA adducts resulting from methylating agents such as MNNG, MNU, temozolomide, and procarbazine; CpG crosslinks resulting from cisplatin and carboplatin; and S(6)-thioguanine and S(6)-methylthioguanine residues in DNA. Although MMR proteins can recognize both replicational errors and chemotherapy-induced adducts in DNA, the end results of this recognition are very different. Base-base mismatches and IDLs can be repaired by MMR, restoring genomic integrity, whereas MMR-mediated recognition and processing of chemotherapy-induced adducts in DNA results in apoptosis. After the loss of MMR, the inability of cells to recognize and correct single base-pair mismatches and insertion-deletion loops can lead to secondary mutations in proto-oncogenes and tumor-suppressor genes, thereby contributing to the development of cancer. In addition, the inability of MMR-deficient cells to recognize chemotherapy-induced adducts in DNA can result in a damage-tolerant phenotype that translates to clinically significant resistance by allowing for selection of MMR-deficient cancer cells. We have shown recently that these MMR-deficient, drug-resistant cells can be targeted for radiosensitization by the halogenated thymidine analogs iododeoxyuridine (IdUrd) and bromodeoxyuridine (BrdUrd). These thymidine (dThd) analogs become incorporated into DNA and form reactive uracil radicals after ionizing radiation (IR), increasing strand breaks. IdUrd and BrdUrd appear to be removed from DNA in MMR-proficient cells with limited toxicity or disruption of the cell cycle, while accumulating at much higher levels in MMR-deficient cells. As a result, it is possible to effectively increase the radiosensitization of MMR-deficient cells at levels of halogenated dThd analog that demonstrate limited toxicity to MMR-proficient cells. This indicates that a combined approach of IdUrd or BrdUrd with IR may be effective in killing MMR-deficient tumors in patients, which are resistant to many cancer chemotherapy agents commonly used in the clinic.

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Fitzek MM, Thornton AF, Harsh G, Rabinov JD, Munzenrider JE, Lev M, Ancukiewicz M, Bussiere M, Hedley-Whyte ET, Hochberg FH, Pardo FS. Dose-escalation with proton/photon irradiation for Daumas-Duport lower-grade glioma: results of an institutional phase I/II trial. Int J Radiat Oncol Biol Phys 2001;51:131-7. [PMID: 11516862 DOI: 10.1016/s0360-3016(01)01589-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

Abstract

PURPOSE

The role of dose escalation with proton/photon radiotherapy in lower-grade gliomas was assessed in a prospective Phase I/II trial. We report the results in terms of local control, toxicity, and survival.

MATERIALS AND METHODS

Twenty patients with Grade 2/4 (n = 7) and Grade 3/4 (n = 13) gliomas according to the Daumas-Duport classification were treated on a prospective institutional protocol at Massachusetts General Hospital/Harvard Cyclotron Laboratory between 1993 and 1996. Doses prescribed to the target volumes were 68.2 cobalt Gray equivalent (CGE, 1 proton Gray = 1.1 CGE) to gross tumor in Grade 2 lesions and 79.7 CGE in Grade 3 lesions. Fractionation was conventional, with 1.8 to 1.92 CGE once per day. Eligibility criteria included age between 18 and 70 years, biopsy-proven Daumas-Duport Grade 2/4 or 3/4 malignant glioma, Karnofsky performance score of 70 or greater, and supratentorial tumor. Median age of the patient population at diagnosis was 35.9 years (range 19-49). Ten tumors were mixed gliomas, one an oligodendroglioma.

RESULTS

Five patients underwent biopsy, 12 a subtotal resection, and 3 a gross total resection. Median interval from surgery to first radiation treatment was 2.9 months. Actuarial 5-year survival rate for Grade 2 lesions was 71% as calculated from diagnosis (median survival not yet reached); actuarial 5-year survival for Grade 3 lesions was 23% (median 29 months). Median follow-up is 61 months and 55 months for 4 patients alive with Grade 2 and 3 patients alive with Grade 3 lesions, respectively. Three patients with Grade 2 lesions died from tumor recurrence, whereas 2 of the 4 survivors have evidence of radiation necrosis. Eight of 10 patients who have died with Grade 3 lesions died from tumor recurrence, 1 from pulmonary embolus, and 1 most likely from radiation necrosis. One of 3 survivors in this group has evidence of radiation necrosis.

CONCLUSION

Tumor recurrence was neither prevented nor noticeably delayed in our patients relative to published series on photon irradiation. Dose escalation using this fractionation scheme and total dose delivered failed to improve outcome for patients with Grade 2 and 3 gliomas.

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Yuan X, Dillehay LE, Williams JR, Shastri VR, Williams JA. IUdR polymers for combined continuous low-dose rate and high-dose rate sensitization of experimental human malignant gliomas. Int J Cancer 2001;96:118-25. [PMID: 11291095 DOI: 10.1002/ijc.1005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]

Abstract

Local polymeric delivery enhances IUdR radiosensitization of human malignant gliomas (MG). The combined low-dose rate (LDR) (0.03 Gy/h) and fractionated high-dose rate (HDR) treatments result in cures of experimental MGs. To enhance efficacy, we combined polymeric IUdR delivery, LDR, and HDR for treatments of both subcutaneous and intracranial MGs. In vitro: Cells (U251 MG) were trypsinized and replated in triplicate 1 day prior to LDR irradiation in media either without (control) or with 10 microM IUdR. After 72 hr, LDR irradiation cells were acutely irradiated (1.1 Gy/min) with increasing (0, 1.25, 2.5, 5.0, or 10 Gy) single doses. Implantable IUdR polymers [(poly(bis(p-carboxyphenoxy)-propane) (PCPP): sebaic acid (PCPP:SA), 20:80] (50% loading; 10 mg) were synthesized. In vivo: For flank vs. intracranial tumors, mice had 6 x 10(6) subcutaneous vs. 2 x 10(5) intracranial cells. For intracranial or subcutaneous MGs, mice had intratumoral blank (empty) vs. IUdR polymer treatments. One day after implantation, mice had immediate external LDR (3 cGy/h x 3 days total body irradiation) or HDR (2 Gy BID x 4 days to tumor site) or concurrent treatments. For the in vitro IUdR treatments, LDR resulted in a striking increase in cell-killing when combined with HDR. For the in vivo LDR treatments of flank tumors, the growth delay was greater for the IUdR vs. blank polymer treatments. For the combined LDR and HDR, the IUdR treatments resulted in a dramatic decrease in tumor volumes. On day 60 the log V/V0 were -1.7 +/- 0.22 for combined LDR + HDR + IUdR polymer (P < 0.05 vs. combined LDR + HDR + blank polymer). Survival for the intracranial controls was 22.9 +/- 1.2 days. For the blank polymer + LDR vs. blank polymer + LDR + HDR treatments, survival was 25.3 +/- 1.7 (P = NS) vs. 48.1 +/- 3.5 days (P < 0.05). For IUdR polymer + LDR treatment survival was 27.3 +/- 2.3 days (P = NS). The most striking improvement in survival followed the IUdR polymer + LDR + HDR treatment: 66.0 + 6.4 days (P < 0.05 vs. blank polymer + LDR + HDR). The polymeric IUdR delivery plus combined continuous LDR and HDR treatments results in growth delay and improved survival in animals bearing the MG xenografts. This treatment may hold promise for the treatment of human MGs.

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Yung WK. BUdR radiosensitization in anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1999;45:1105-6. [PMID: 10613300 DOI: 10.1016/s0360-3016(99)00264-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]

Prados MD, Scott C, Sandler H, Buckner JC, Phillips T, Schultz C, Urtasun R, Davis R, Gutin P, Cascino TL, Greenberg HS, Curran WJ. A phase 3 randomized study of radiotherapy plus procarbazine, CCNU, and vincristine (PCV) with or without BUdR for the treatment of anaplastic astrocytoma: a preliminary report of RTOG 9404. Int J Radiat Oncol Biol Phys 1999;45:1109-15. [PMID: 10613302 DOI: 10.1016/s0360-3016(99)00265-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]

Abstract

PURPOSE

This study was an open label, randomized Phase 3 trial in newly diagnosed patients with anaplastic glioma comparing radiotherapy plus adjuvant procarbazine, CCNU, and vincristine (PCV) chemotherapy with or without bromodeoxyuridine (BUdR) given as a 96-hour infusion each week of radiotherapy.

METHODS AND MATERIALS

Only patients 18 years or older with newly diagnosed anaplastic glioma were eligible; central pathology review was accomplished, but was not mandated prior to registration. The study had initially opened as a Northern California Oncology Group (NCOG) trial in 1991, becoming an Intergroup RTOG, SWOG, and NCCTG study in July 1994. Total accrual of 293 patients was planned as the sample size, using survival and time to tumor progression as the primary endpoints. The experiment arm (RT/BUdR plus PCV) was to be compared to the control arm (RT plus PCV) using an alpha = 0.05, one-tailed, with a power of 85% for detecting an increase in median survival from 160 to 240 weeks, assuming a 3-year follow-up after completion of enrollment.

RESULTS

As of July 1996, 281 patients had been randomized; 53 (20%) were ineligible, primarily based upon central pathology review, and another 39 cases were canceled. In total, 30% of cases were excluded from analysis. The treatment arms were well balanced despite this rate of exclusion. The RTOG Data Monitoring Committee recommended suspension of enrollment in July 1996 based upon a stochastic curtailment analysis which strongly suggested that the addition of BUdR would not be associated with increased survival. In February 1997, the study was closed prior to full enrollment. At that time, the 1-year survival estimates were 82% versus 68% for RT plus PCV and RT/BUdR plus PCV respectively (one-sided, p = 0.96). The conditional power analysis indicated that even with an additional 12 months of additional accrual and follow-up the probability of detecting the prespecified difference was less than 0.01%. The differences in the two arms seem to be due to early deaths in the BUdR arm, not related to toxicity of the treatment.

CONCLUSIONS

Despite encouraging Phase 2 results with BUdR, it is unlikely that a survival benefit will be seen. A final study analysis will not be done for at least 3 more years.

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Prados MD, Scott C, Curran WJ, Nelson DF, Leibel S, Kramer S. Procarbazine, lomustine, and vincristine (PCV) chemotherapy for anaplastic astrocytoma: A retrospective review of radiation therapy oncology group protocols comparing survival with carmustine or PCV adjuvant chemotherapy. J Clin Oncol 1999;17:3389-95. [PMID: 10550132 DOI: 10.1200/jco.1999.17.11.3389] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open

Abstract

PURPOSE

To determine any differences in outcome for patients with anaplastic astrocytoma (AA) treated with adjuvant carmustine (BCNU) versus procarbazine, lomustine, and vincristine (PCV) chemotherapy.

MATERIALS AND METHODS

The Radiation Therapy Oncology Group (RTOG) database was reviewed for patients with newly diagnosed AA treated according to protocols that included either BCNU or PCV adjuvant chemotherapy. All patients were treated with radiation therapy. The outcome analysis included overall survival, taking into account patient age, extent of resection, Karnofsky performance status (KPS), and treatment group (BCNU v PCV). Stratified and nonstratified Cox proportional hazards models were used, as well as an analysis using matched cases between the groups.

RESULTS

A total of 257 patients were treated with BCNU according to RTOG protocols 70-18, 83-02, and 90-06; 175 patients were treated with PCV according to RTOG protocol 94-04. All pretreatment characteristics except KPS were well balanced by treatment group; 61% of the BCNU group had a KPS of 90 to 100 compared with 73% of the PCV group (P =.0075). No statistically significant difference in survival was observed in any age group or by KPS or extent of surgery. The stratified analysis also showed no trends for improved survival by treatment group (P =. 40). The Cox model identified only age, KPS, and extent of surgery as important variables influencing survival, not treatment group. Matching cases between groups using age, KPS, and surgery resulted in 133 matched pairs. No difference in survival was observed (P =. 41). In a Cox model in which each matched pair is a strata, there was no difference between groups (P =.20).

CONCLUSION

Using this retrospective analysis, there does not seem to be any survival benefit to PCV chemotherapy. Future phase III studies for patients with AA may need to consider whether BCNU or PCV is used in the control arm.

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Groves MD, Maor MH, Meyers C, Kyritsis AP, Jaeckle KA, Yung WK, Sawaya RE, Hess K, Bruner JM, Peterson P, Levin VA. A phase II trial of high-dose bromodeoxyuridine with accelerated fractionation radiotherapy followed by procarbazine, lomustine, and vincristine for glioblastoma multiforme. Int J Radiat Oncol Biol Phys 1999;45:127-35. [PMID: 10477016 DOI: 10.1016/s0360-3016(99)00122-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]

Williams JA, Yuan X, Dillehay LE, Shastri VR, Brem H, Williams JR. Synthetic, implantable polymers for local delivery of IUdR to experimental human malignant glioma. Int J Radiat Oncol Biol Phys 1998;42:631-9. [PMID: 9806525 DOI: 10.1016/s0360-3016(98)00258-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]

Abstract

PURPOSE

Recently, polymeric controlled delivery of chemotherapy has been shown to improve survival of patients with malignant glioma. We evaluated whether we could similarly deliver halogenated pyrimidines to experimental intracranial human malignant glioma. To address this issue we studied the in vitro release from polymers and the in vivo drug delivery of IUdR to experimental human U251 glioblastoma xenografts.

METHODS AND MATERIALS

In vitro: To measure release, increasing (10%, 30%, 50%) proportions of IUdR in synthetic [(poly(bis(p-carboxyphenoxy)-propane) (PCPP):sebacic acid (SA) polymer discs were serially incubated in buffered saline and the supernatant fractions were assayed. In vivo: To compare local versus systemic delivery, mice bearing flank xenografts had intratumoral or contralateral flank IUdR polymer (50% loading) treatments. Mice bearing intracranial (i.c.) xenografts had i.c. versus flank IUdR polymer treatments. Four or 8 days after implantation of polymers, mice were sacrificed and the percentage tumor cells that were labeled with IUdR was measured using quantitative microscopic immunohistochemistry.

RESULTS

In vitro: Increasing percentage loadings of IUdR resulted in higher percentages of release: 43.7 + 0.1, 70.0 + 0.2, and 90.2 + 0.2 (p < 0.001 ANOVA) for the 10%, 30%, and 50% loadings, respectively. In vivo: For the flank tumors, both the ipsilateral and contralateral IUdR polymers resulted in similarly high percentages labeling of the tumors versus time. For the ipsilateral IUdR polymers, the percentage of tumor cellular labeling after 4 days versus 8 days was 45.8 +/- 7.0 versus 40.6 +/- 3.9 (p = NS). For the contralateral polymer implants, the percentage of tumor cellular labeling were 43.9 +/- 10.1 versus 35.9 +/- 5.2 (p = NS) measured 4 days versus 8 days after implantation. For the i.c. tumors treated with extracranial IUdR polymers, the percentage of tumor cellular labeling was low: 13.9 +/- 8.8 and 11.2 +/- 5.7 measured 4 and 8 days after implantation. For the i.c. tumors having the i.c. IUdR polymers, however, the percentage labeling was comparatively much higher: 34.3 +/- 4.9 and 35.3 +/- 4.0 on days 4 and 8, respectively. For the i.c. tumors, examination of the percentage cellular labeling versus distance from the implanted IUdR polymer showed that labeling was highest closest to the polymer disc.

CONCLUSION

Synthetic, implantable biodegradable polymers provide the local, controlled release of IUdR and result in the high, local delivery of IUdR to experimental intracranial human malignant glioma. This technique holds promise for the local delivery of IUdR for radiosensitization of human brain tumors.

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Prados MD, Scott CB, Rotman M, Rubin P, Murray K, Sause W, Asbell S, Comis R, Curran W, Nelson J, Davis RL, Levin VA, Lamborn K, Phillips TL. Influence of bromodeoxyuridine radiosensitization on malignant glioma patient survival: a retrospective comparison of survival data from the Northern California Oncology Group (NCOG) and Radiation Therapy Oncology Group trials (RTOG) for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 1998;40:653-9. [PMID: 9486616 DOI: 10.1016/s0360-3016(97)00770-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Abstract

PURPOSE

To examine the effect of treatment using Bromodeoxyuridine (BrdU) during radiation therapy on malignant glioma patient survival by comparing historical survival data from several large clinical trials.

METHODS

A retrospective analysis of patient data from Radiation Therapy Oncology Group (RTOG) trials 74-01, 79-18, and 83-02 and the Northern California Oncology Group (NCOG) study 6G-82-1 was conducted. Patient data was supplied by both groups, and analyzed by the RTOG. Pretreatment characteristics including age, extent of surgery, Karnofsky Performance Status (KPS), and histopathology were collected; the only treatment variable evaluated was the use of BrdU during radiation therapy. Radiation dose, dose-fractionation schedule, use of chemotherapy, and/or type of chemotherapy was not controlled for in the analyses. Univariate and multivariate analyses were conducted to examine the potential treatment effect of BrdU on patient survival.

RESULTS

Data from 334 patients treated with BrdU on NCOG 6G-82-1 and 1743 patients treated without BrdU on 3 RTOG studies was received. Patients were excluded from the review if confirmation of eligibility could not be obtained, if the patient was ineligible for the study they entered, if central pathology review was not done, or if radiotherapy data was not available. Patients treated according to the RTOG studies had to start radiotherapy within 4 weeks of surgery; no such restriction existed for the NCOG studies. To ensure comparability between the studies, patients from the NCOG studies who began treatment longer than 40 days from surgery were also excluded. The final data set included 296 cases from the NCOG studies (89%) and 1478 cases from the RTOG studies (85%). For patients with glioblastoma multiforme (GBM) the median survival was 9.8 months in the RTOG studies and 13.0 months in the NCOG trial (p < 0.0001). For patients with AA the median survival was 35.1 months for the RTOG studies and 42.8 months in the NCOG trial (p = 0.126). Univariate results showed consistent results favoring BrdU among patients over 30 years of age, across the extent of surgery, and for GBM patients. A proportional hazards regression model that included treatment, histopathology, KPS, age, and extent of surgery demonstrated that treatment with BrdU was included in the best model only for the GBM group of patients (risk ratio 0.83).

CONCLUSIONS

Because of the heterogeneity of the treatment groups, including potentially important differences in pathology reviewers assessment of nonglioblastoma cases, differences in radiation dose and schedules, and chemotherapy during or after radiation, these analyses cannot provide the definitive answer as to whether BrdU given during radiation therapy improves survival in patients with malignant glioma. There does appear to be a favorable treatment effect seen in patients with GBM, with a lesser effect in patients with AA.

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Chemoradiation strategies for patients with malignant glioma. Semin Radiat Oncol 1997. [DOI: 10.1016/s1053-4296(97)80058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]

Merchant TE, Haida T, Wang MH, Finlay JL, Leibel SA. Anaplastic ependymoma: treatment of pediatric patients with or without craniospinal radiation therapy. J Neurosurg 1997;86:943-9. [PMID: 9171172 DOI: 10.3171/jns.1997.86.6.0943] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Abstract

The authors conducted a retrospective review of the clinical and treatment characteristics and outcomes in 28 pediatric patients with anaplastic ependymoma treated with radiation therapy since the advent of computerized tomography (CT) (1978-1994). Twelve patients received craniospinal irradiation followed by a boost to the primary site, two received whole-brain radiation therapy followed by a boost to the primary site, and the remaining 14 were treated with focal radiation therapy. The mean dose to the primary site was 5486 cGy. With a median follow-up period of 86 months for the 14 surviving patients (range 31-201 months), the median disease-free survival, measured from the date of diagnosis to the time of recurrence after radiation therapy, was 40 months. The median disease-free survival measured from the start of radiation therapy was 32 months. The median overall survival rate has not been reached and the actuarial estimates of overall survival rates at 5 and 10 years were 56% and 38%, respectively. According to univariate analysis, the disease-free survival rate was significantly improved (p < 0.01) in patients who underwent a gross-total resection at diagnosis. Overall survival rates were negatively influenced by treatment with craniospinal and whole-brain irradiation. As calculated by multivariate analysis, increasing dosage to the primary site (p < 0.05), infratentorial location (p < 0.01), and gross-total resections (p < 0.02) resulted in the longest disease-free survival times. All 19 patients in whom treatment failed after radiation therapy suffered a recurrence at the primary site. In addition, one of these patients experienced subarachnoid dissemination. Radiation treatment recommendations for patients with ependymoma have been based on the tumor's location, perceived risk for dissemination, and malignant propensity. The significance of anaplastic histological classification is controversial. Differences in the disease-free and overall survival rates have been demonstrated between ependymomas and anaplastic ependymomas treated in the pre-CT era. The results of this study show that there is no benefit from craniospinal irradiation in this group of patients.

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Brock CS, Bower M. Current perspectives in gliomas. Med Oncol 1997;14:103-20. [PMID: 9330270 DOI: 10.1007/bf02990955] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]

Williams JA, Dillehay LE, Tabassi K, Sipos E, Fahlman C, Brem H. Implantable biodegradable polymers for IUdR radiosensitization of experimental human malignant glioma. J Neurooncol 1997;32:181-92. [PMID: 9049879 DOI: 10.1023/a:1005704913330] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Abstract

PURPOSE

The potential of halogenated pyrimidines for the radiosensitization of human malignant gliomas remains unrealized. To assess the role of local delivery for radiosensitization, we tested a synthetic, implantable biodegradable polymer for the controlled release of 5-iodo-2'-deoxyuridine (IUdR) both in vitro and in vivo and the resultant radiosensitization of human malignant glioma xenografts in vivo.

MATERIALS AND METHODS

In vitro: To measure release, increasing (10%, 30%, 50%) proportions (weight/weight) of IUdR in the polyanhydride [(poly(bis(p-carboxyphenoxy)-propane) (PCPP): sebacic acid (SA) (PCPP : SA ratio 20:80)] polymer discs were incubated (1 ml phosphate-buffered saline, 37 degrees C). The supernatant fractions were serially assayed using high performance liquid chromatography. To measure modulation of release, polymer discs were co-loaded with 20 microCi 5-125-iodo-2'-deoxyuridine (125-IUdR) and increasing (10%, 30%, or 50%) proportions of D-glucose. To test radiosensitization, cells (U251 human malignant glioma) were sequentially exposed to increasing (0 or 10 microM) concentrations of IUdR and increasing (0, 2.5, 5.0, or 10 Gy) doses of acute radiation. In vivo. To measure release, PCPP : SA polymer discs having 200 microCi 125-IUdR were surgically placed in U251 xenografts (0.1-0.2 cc) growing in the flanks of nude mice. The flanks were reproducibly positioned over a collimated scintillation detector and counted. To measure radiosensitization, PCPP : SA polymer discs having 0% (empty) or 50% IUdR were placed in the tumor or contralateral flank. After five days, the tumors were acutely irradiated (500 cGy x 2 daily fractions).

RESULTS

In vitro: Intact IUdR was released from the PCPP : SA polymer discs in proportion to the percentage loading. After 4 days the cumulative percentages of loaded IUdR that were released were 43.7 +/- 0.1, 70.0 +/- 0.2, and 90.2 +/- 0.2 (p < 0.001 ANOVA) for the 10, 30, and 50% loadings. With 0, 10, 30, or 50% D-glucose co-loading, the cumulative release of 125-IUdR from PCPP : SA polymers was 21, 70, 92, or 97% (p < 0.001), respectively, measured 26 days after incubation. IUdR radiosensitized U251 cells in vitro. Cell survival (log10) was -2.02 +/- 0.02 and -3.68 +/- 0.11 (p < 0.001) after the 10 Gy treatment and no (control) or 10 microM IUdR exposures, respectively. In vivo: 125-IUdR Release: The average counts (log10 cpm +/- SEM) (hours after implant) were 5.2 +/- 0.05 (0.5), 4.3 +/- 0.07 (17), 3.9 +/- 0.08 (64), and 2.8 +/- 0.06 (284). Radiosensitization: After intratumoral implantation of empty polymer or intratumoral 50% IUdR polymer, or implantation of 50% IUdR polymers contralateral to tumors the average growth delays of tumors to 4 times the initial volumes were 15.4 +/- 1.8, 20.1 + 0.1, and 20.3 + 3.6 (mean + SEM) days, respectively (p = 0.488 one-way ANOVA). After empty polymer and radiation treatments, no tumors regressed and the growth delay was 31.1 + 2.1 (p = 0.046 vs. empty polymer alone) days. After implantation of 50% IUdR polymers either contralateral to the tumors or inside the tumors, followed by radiation, tumors regressed; growth delays to return to the initial average volumes of 14.0 + 3.6 or 24.2 + 0.2 (p < 0.01) days, respectively.

CONCLUSIONS

Synthetic, implantable biodegradable polymers hold promise for the controlled release and local delivery of IUdR for radiosensitization of gliomas.

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Urtasun RC, Kinsella TJ, Farnan N, DelRowe JD, Lester SG, Fulton DS. Survival improvement in anaplastic astrocytoma, combining external radiation with halogenated pyrimidines: final report of RTOG 86-12, Phase I-II study. Int J Radiat Oncol Biol Phys 1996;36:1163-7. [PMID: 8985039 DOI: 10.1016/s0360-3016(96)00429-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

Abstract

PURPOSE

This study evaluated the toxicity and tumor efficacy of the halopyrimidine IUdR as a chemical modifier of radiation response in patients with malignant glioma. The preliminary results published in 1993 demonstrated no real advantage in the group of patients with glioblastoma. However, a benefit appeared to be evolving in the group of patients with Anaplastic Astrocytoma (AA). We are now presenting the results on the long-term follow-up of patients with AA.

METHODS AND MATERIALS

Between August 1987 and October 1991, 79 patients were entered in a prospective study with newly diagnosed malignant glioma. Twenty-one of 79 were AA. The study was designed to have a fixed dose of radiation consisting of 60.16 Gy in 32 fractions in 6.5 weeks but varying the dose schedule of IUdR, delivered in a continuous intravenous infusion of long (96 h) or short (48 and 24 h) duration, every week for the 6.5 weeks of radiation treatment.

RESULTS

The last AA patient was entered in March 1991. Ninety-five percent of the AA patients were under 59 years of age and 86% had a Karnofsky score 80. Thirty-eight percent had a tumor diameter of less than 5 cm and 52% had a tumor diameter between 5-10 cm. Seventy-six percent had partial or total tumor resection. The toxicity of this treatment was acceptable and has already been published elsewhere. At the time of this report, 14 out of 21 patients with AA are dead. The median survival, calculated from the Kaplan-Meier, is 3.2 years. Thirty-three percent of the patients have survived 5 years. These results compare favorably with the best results reported in the literature with postoperative external radiation plus chemotherapy, median survival time (MST) of 3 years, and previous Radiation Therapy Oncology Group (RTOG) experience with radiation alone, MST of 2 years.

CONCLUSIONS

Our findings in patients with AA corroborate the improved therapeutic results published recently when combining external radiation with "long" infusion of i.v. BUdR and indicate the need to proceed with randomized Phase III studies utilizing halogenated pyrimidines and radiation. One such study has already been activated, RTOG # 94-04.

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Phillips TL. Comment on "survival improvement in anaplastic astrocytoma, combining external radiation with halogenated pyrimidines: final report of RTOG 86-12, Phase I-II Study". Int J Radiat Oncol Biol Phys 1996;36:1281-2. [PMID: 8985057 DOI: 10.1016/s0360-3016(96)00517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

Andres MS, Hilton BL, Steven O, Meir K, Barbara S, Douglas B, Hernando M, Norman M, Karen S, Daniel D, David D, Morris P, Mark I, Maria G, Herbert B, Alex O. Long-term Treatment of Malignant Gliomas with Intramuscularly Administered Polyinosinic-Polycytidylic Acid Stabilized with Polylysine and Carboxymethylcellulose: An Open Pilot Study. Neurosurgery 1996. [DOI: 10.1097/00006123-199606000-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open

Salazar AM, Levy HB, Ondra S, Kende M, Scherokman B, Brown D, Mena H, Martin N, Schwab K, Donovan D, Dougherty D, Pulliam M, Ippolito M, Graves M, Brown H, Ommaya A. Long-term Treatment of Malignant Gliomas with Intramuscularly Administered Polyinosinic-Polycytidylic Acid Stabilized with Polylysine and Carboxymethylcellulose: An Open Pilot Study. Neurosurgery 1996. [DOI: 10.1227/00006123-199606000-00006] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open

Barker FG, Davis RL, Chang SM, Prados MD. Necrosis as a prognostic factor in glioblastoma multiforme. Cancer 1996;77:1161-6. [PMID: 8635139 DOI: 10.1002/(sici)1097-0142(19960315)77:6<1161::aid-cncr24>3.0.co;2-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Abstract

BACKGROUND

Many pathologists require the presence of tumor necrosis within an astrocytic neoplasm to establish the diagnosis of glioblastoma multiforme (GM). Two new grading systems for astrocytic neoplasms allow a tumor to be diagnosed at the highest level of anaplasia without requiring the presence of tumor necrosis.

METHODS

To determine whether GMs without necrosis had biologic behavior most compatible with a diagnosis of GM or of anaplastic astrocytoma (AA), we examined the survival of 299 patients whose tumors were diagnosed as GM because they contained endothelial proliferation and who were treated according to prospective clinical protocols. Multivariate proportional-hazards survival analysis was used to assess the importance of tumor necrosis after adjustment for other prognostic factors.

RESULTS

Of 275 patients with GMs containing endothelial proliferation, 88% had tumor necrosis. Absence of necrosis was associated with younger age and with less extensive surgical resection. The absence of necrosis predicted longer survival in univariate analysis (P = 0.02) and after adjustment for age, Karnofsky performance score, and extent of resection in a multivariate analysis (P = 0.04). However, the magnitude of the survival difference was not clinically important: patients without tumor necrosis had a median survival of 12.5 months, and those with tumor necrosis had a median survival of 10.9 months. Kaplan-Meier survival rates two years after diagnosis were 13.0% for patients with necrosis and 27.1% for patients without necrosis; the difference in 2-year survival was not statistically significant (difference in survival rates = 14.1%, 95% confidence interval -2.2% to 30.4%).

CONCLUSIONS

The survival of patients with astrocytic neoplasms containing endothelial proliferation and no necrosis conforms best to the pattern expected for patients with GM rather than AA. This supports the classification of these tumors as GM in the revised World Health Organization grading system and as grade 4 astrocytomas in the St. Anne-Mayo grading system.

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Phillips TL, Scott CB, Leibel SA, Rotman M, Weigensberg IJ. Results of a randomized comparison of radiotherapy and bromodeoxyuridine with radiotherapy alone for brain metastases: report of RTOG trial 89-05. Int J Radiat Oncol Biol Phys 1995;33:339-48. [PMID: 7673021 DOI: 10.1016/0360-3016(95)00168-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]

Abstract

PURPOSE

To determine if the addition of bromodeoxyuridine (BrdUrd) to radiotherapy prolongs survival when compared to radiotherapy alone in patients with brain metastases.

METHODS AND MATERIALS

Seventy-two patients with brain metastases were randomized to 37.5 Gy in 15 fractions of 2.5 Gy or to the same dose with BrdUrd 0.8 g/m2 per day for 4 days of each of 3 weeks. Drug treatment was begun on Thursday or Friday before the first week of radiotherapy. Patients had a Karnofsky performance score of at least 70, a neurological function classification of 1 or 2, and any primary tumor except central nervous system (CNS), leukemia, or lymphoma. The primary was absent, controlled, or under active radiotherapy. Patients were free of other metastases. They were stratified by primary site (breast, lung or other), number of metastases (single or multiple) and age (< 60 vs. > 60).

RESULTS

There was no significant difference between the two treatment arms (p = 0.904). The study was open from October 1989 to March 1993 and accrued 72 patients. Only one patient in the RT only arm remains alive. The two treatment arms were balanced with respect to all stratification variables. Toxicity due to radiotherapy was similar in both arms. BrdUrd caused significant Grade 4 and 5 hematologic and skin toxicity in five patients. Two patients died due to hematologic toxicity and one from a Stevens-Johnson type skin reaction. Phenytoin played a role in the skin reactions and ranitidine was associated with the hematologic deaths. Ranitidine was eliminated, BrdUrd was discontinued after any hematologic toxicity, and no further Grade 4 or 5 toxicities were seen. The median survival was 6.12 months in the radiotherapy group and 4.3 in the BrdUrd group (p = 0.904). Patients with solitary brain metastases had significantly better survival (p = 0.031).

CONCLUSIONS

BrdUrd did not enhance the efficacy of the radiotherapy regimen tested, in spite of the fact that brain metastases have shown high labeling indices. The toxicity of this schedule of BrdUrd administration was apparently increased by ranitidine and phenytoin.

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