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The Outcomes of Concomitant Chemoradiotherapy Followed by Adjuvant Chemotherapy with Temozolomide for Newly Diagnosed High Grade Gliomas : The Preliminary Results of Single Center Prospective Study

  • Choi, Jung-Won (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Lee, Min-Mi (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, In-Ah (Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Jee-Hyun (Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Choe, Ghee-Young (Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Chae-Yong (Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Published : 2008.10.28

Abstract

Objective : Malignant gliomas are the most common primary cerebral neoplasms in adults. Despite multimodality treatments, the prognosis for patients with malignant glioma remains poor. However, recently, the effectiveness of concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) has been reported. We report for the first time preliminary results of the treatment with CCRT of newly diagnosed malignant gliomas in Korean people. Methods : Thirty-two patients over the age of 17 years with newly diagnosed and histologically confirmed high-grade gliomas (HGG), from June 2004 to August 2007 were the subjects of this study. There were 17 men and 15 women, with a median age of 53.5 years (range, 17-74). Pathologically, glioblastoma, anaplastic astrocytoma, anaplastic oligodendroglioma, and gliomatosis cerebri had been diagnosed in eighteen, eight, four, and two patients, respectively. These 32 patients were treated with CCRT with TMZ. Results : The median follow-up period was 12.5 months (range 3-48). At the time of this analysis, 13 patients died and three patients had been lost to follow-up. There was no mortality caused by drug toxicity. The median progression-free survival (PFS) of these patients was 9.0 months, and the six-month PFS rate was 72.4%. The median overall survival (OS) was 26 months, and the one-year OS rate was 83.6%. The 18 patients with glioblastoma were analyzed separately from the other patients with HGG, and the median OS was 18 months, and the one-year OS rates were 81.8%. The median PFS was seven months, and the six-month PFS rate was 75.0%. Conclusion : Our results are consistent with many other reports, confirming that CCRT with TMZ achieves good clinical outcomes in the treatment of HGG. Therefore, we suggest that CCRT with TMZ as adjuvant chemotherapy be considered as a standard therapy for patients with HGG.

Keywords

References

  1. Brada M, Hoang-Xuan K, Rampling R, Dietrich PY, Dirix LY, Macdonald D, et al : Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol 12 : 259-266, 2001 https://doi.org/10.1023/A:1008382516636
  2. Brandes AA, Franceschi E, Tosoni A, Blatt V, Pession A, Tallini G, et al : MGMT promoter methylation status can predict the incidence and outcome of pseudoprogression after concomitant radiochemotherapy in newly diagnosed glioblastoma patients. J Clin Oncol 26 : 2192-2197, 2008 https://doi.org/10.1200/JCO.2007.14.8163
  3. Cairncross G, Berkey B, Shaw E, Jenkins R, Scheithauer B, Brachman D, et al : Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma : Intergroup Radiation Therapy Oncology Group Trial 9402. J Clin Oncol 24 : 2707-2714, 2006 https://doi.org/10.1200/JCO.2005.04.3414
  4. Corsa P, Parisi S, Raguso A, Troiano M, Perrone A, Cossa S, et al : Temozolomide and radiotherapy as first-line treatment of highgrade gliomas. Tumori 92 : 299-305, 2006 https://doi.org/10.1177/030089160609200407
  5. Friedman HS, McLendon RE, Kerby T, Dugan M, Bigner SH, Henry AJ, et al : DNA mismatch repair and O6-alkylguanine-DNA alkyltransferase analysis and response to Temodal in newly diagnosed malignant glioma. J Clin Oncol 16 : 3851-3857, 1998 https://doi.org/10.1200/JCO.1998.16.12.3851
  6. Galanis E, Buckner J : Chemotherapy for high-grade gliomas. Br J Cancer 82 : 1371-1380, 2000 https://doi.org/10.1054/bjoc.1999.1075
  7. Kocher M, Kunze S, Eich HT, Semrau R, Muller RP : Efficacy and toxicity of postoperative temozolomide radiochemotherapy in malignant glioma. Strahlenther Onkol 181 : 157-163, 2005 https://doi.org/10.1007/s00066-005-1314-x
  8. Mahaley MS Jr, Mettlin C, Natarajan N, Laws ER Jr, Peace BB : National survey of patterns of care for brain-tumor patients. J Neurosurg 71 : 826-836, 1989 https://doi.org/10.3171/jns.1989.71.6.0826
  9. Perry J, Laperriere N, Zuraw L, Chambers A, Spithoff K, Cairncross JG : Adjuvant chemotherapy for adults with malignant glioma : a systematic review. Can J Neurol Sci 34 : 402-410, 2007 https://doi.org/10.1017/S0317167100007265
  10. Sathornsumetee S, Rich JN, Reardon DA : Diagnosis and treatment of high-grade astrocytoma. Neurol Clin 25 : 1111-1139, 2007 https://doi.org/10.1016/j.ncl.2007.07.004
  11. Siker ML, Chakravarti A, Mehta MP : Should concomitant and adjuvant treatment with temozolomide be used as standard therapy in patients with anaplastic glioma? Crit Rev Oncol Hematol 60 : 99-111, 2006 https://doi.org/10.1016/j.critrevonc.2006.04.005
  12. Simon JM, Toubiana T, Lang P, Taillibert S, Mazeron JJ : [Radiotherapy for glioblastomas : from radiobiology to concomitant chemotherapy]. Cancer Radiother 9 : 322-331, 2005 https://doi.org/10.1016/j.canrad.2005.07.001
  13. Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, et al : Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 20 : 1375-1382, 2002 https://doi.org/10.1200/JCO.20.5.1375
  14. Stupp R, Hegi ME, Gilbert MR, Chakravarti A : Chemoradiotherapy in malignant glioma : standard of care and future directions. J Clin Oncol 25 : 4127-4136, 2007 https://doi.org/10.1200/JCO.2007.11.8554
  15. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al : Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352 : 987-996, 2005 https://doi.org/10.1056/NEJMoa043330
  16. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, et al : Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49 : 333-343, 1978 https://doi.org/10.3171/jns.1978.49.3.0333
  17. Walker MD, Green SB, Byar DP, Alexander E Jr, Batzdorf U, Brooks WH, et al : Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery. N Engl J Med 303 : 1323-1329, 1980 https://doi.org/10.1056/NEJM198012043032303
  18. Yung WK, Albright RE, Olson J, Fredericks R, Fink K, Prados MD, et al : A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer 83 : 588-593, 2000 https://doi.org/10.1054/bjoc.2000.1316

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