title: Conventional radiotherapy combined with carbogen breathing and nicotinamide for malignant gliomas.
abstract: High grade malignant gliomas are among the most radioresistant human tumors and total doses up to 80 Gy are inadequate to achieve long-term local control in most of the patients. Hypoxia has been demonstrated in primary brain tumors and may be one of the reasons for their radioresistance. In experimental models carbogen breathing and nicotinamide have been shown to act against hypoxia by different mechanisms and both modalities were tested in 16 patients with supratentorial malignant gliomas in combination with a conventional radiotherapy scheme (50 Gy in 25 daily fractions). The present study was performed to determine the feasibility and toxicity of conventional radiotherapy combined with carbogen breathing and nicotinamide. The unexpectedly high incidence of acute liver toxicity, the possible increase of subacute and late CNS toxicity, and the absence of a higher effectivity led us to reconsider this new treatment modality for patients with malignant gliomas.
authors.affiliation: Institute of Radiotherapy, University of Nijmegen, The Netherlands.
authors.forename: R W
authors.initials: RW
authors.lastname: van der Maazen
authors.forename: H O
authors.initials: HO
authors.lastname: Thijssen
authors.forename: J H
authors.initials: JH
authors.lastname: Kaanders
authors.forename: A
authors.initials: A
authors.lastname: de Koster
authors.forename: A
authors.initials: A
authors.lastname: Keyser
authors.forename: M J
authors.initials: MJ
authors.lastname: Prick
authors.forename: J A
authors.initials: JA
authors.lastname: Grotenhuis
authors.forename: P
authors.initials: P
authors.lastname: Wesseling
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Kogel
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage*; D010100:Oxygen / Q000008:administration & dosage*; D011832:Radiation Injuries / Q000517:prevention & control; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage*
chemical_list: D011838:Radiation-Sensitizing Agents; D002245:Carbon Dioxide; D009536:Niacinamide; C011700:carbogen; D010100:Oxygen