A concurrent ultra-fractionated radiation therapy and temozolomide treatment: A promising therapy for newly diagnosed, inoperable glioblastoma

We report on a phase II clinical trial to determine the effect of a concurrent ultra-fractionated radiotherapy and temozolomide treatment in inoperable glioblastoma patients. A phase II study opened; patients over 18 years of age who were able to give informed consent and had histologically proven, newly diagnosed inoperable diagnosed and supratentorial glioblastoma were eligible. Three doses of 0.75 Gy spaced apart by at least 4 hr were delivered daily, 5 days a week for six consecutive weeks for a total of 67.5 Gy. Chemotherapy was administered during the same period, which consisted of temozolomide given at a dose of 75 mg/m(2) for 7 days a week. After a 4-week break, chemotherapy was resumed for up to six cycles of adjuvant temozolomide treatment, given every 28 days, according to the standard 5-day regimen. Tolerance and toxicity were the primary endpoints; survival and progression-free survival were the secondary endpoints. In total, 40 patients were enrolled in this study, 29 men and 11 women. The median age was 58 years, and the median Karnofsky performance status was 80. The concomitant ultra-fractionated radiotherapy and temozolomide treatment was well tolerated. Complete responses were seen in four patients, and partial responses were reported in seven patients. The median survival from the initial diagnosis was 16 months. Several long-term survivors were noted. Concurrent ultra-fractionated radiation therapy and temozolomide treatment are well accepted by the patients. The results showed encouraging survival rates for these unfavorable patients.

Methotrexate (MTX), procarbazine and CCNU for primary central nervous system lymphoma (PCNSL) in patients younger than 60: Can radiotherapy (RT) be deferred?

1551

Background: Deferring RT following MTX based chemotherapy has been an acceptable initial approach for elderly PCNSL pts because of a high risk of neurotoxicity (NT). However, given the lower NT risk, such an approach is more controversial in younger pts . In this study we report outcomes of an innovative MTX-based regimen for PCNSL pts younger than 60 and seek to investigate whether withholding RT is an acceptable option in selected pts. Methods: We reviewed records of all patients <60y with confirmed PCNSL seen in 3 institutions from 1994 to 2003. Through prior agreement among institutions, pts were offered a standardized treatment consisting of an induction chemotherapy with MTX (3g/m2- days 1, 10, and 20), CCNU (40 mg/m2- day 1), procarbazine (60 mg/m2- days 1–7), methylprednisolone (120 mg/m2- days 1–20) and IT MTX (15mg), cytarabine (40 mg) and methylprednisolone (40mg)- days 1, 5, 10 and 15. Pts with a complete response (CR) proceeded to a maintenance chemotherapy consisting of 5 monthly cycles with same doses of MTX- day 1, CCNU- day 1, procarbazine- days 1–7, and same IT chemotherapy on day 1; those patients received no further treatment. Pts with less than a CR to induction were treated on an individual basis, and typically received consolidation with RT or high-dose chemotherapy (HDC) with stem cell rescue. Results: Among the 64 identified pts, median age was 47 (19–60), median KPS was 70 (20–100), and 41 (64%) were men. For the entire population, median progression-free survival (PFS) was 13m and median overall survival (OS) has not been reached (median follow-up: 54m). 90% of patients responded to induction treatment (CR: 52%; PR: 38%). Consolidation or salvage treatment with RT has been given to a total of 27 pts, and HDC to 23. For the 26 pts who completed maintenance chemotherapy and received no further treatment, median PFS was 36m. Grades 3/4 hematotoxicity developed in 18 pts, nephrotoxicity in 2 pts, and NT in 6 patients (none in the chemotherapy-only treated patients). Two toxic deaths occurred. Conclusions: Deferring RT in chemosensitive patients seems to compromise PFS but not OS, with minimal NT. HDC and RT are effective salvage treatments. Further studies on the role of RT versus HDC in younger patients are warranted.

No significant financial relationships to disclose.