title: Carbogen and nicotinamide combined with unconventional radiotherapy in glioblastoma multiforme: a new modality treatment.
abstract: OBJECTIVE
  A new radiotherapy schedule to treat glioblastoma multiforme after surgery, combining nicotinamide and carbogen.
  
  
  METHODS
  We analyzed 36 patients with glioblastoma multiforme treated after surgery with radiotherapy, Nicotinamide and Carbogen as follows: 7 patients were treated with accelerated fractionation: two fractions/day, 1.5 cGy/fraction, 6 h interval, 5 days/week, total dose 60 Gy in 4 weeks; 8 patients were treated with the same irradiation scheduling plus Nicotinamide at the dose of 4 g and 2 g in capsules, respectively, 1 h before the first and the second irradiation fraction; 21 patients were treated with accelerated radiotherapy, Nicotinamide, and Carbogen (inhaled 10 min before radiotherapy and during the whole course of irradiation). On the basis of surgical removal our patients were subdivided in three groups: totally resected, with residual tumor <50%, or >50%. Radiotherapy with accelerated fractionation was completed in the scheduled time without side effects on the whole group of patients and Carbogen inhalation did not cause significant change of cardiopulmonar parameters. The toxicity observed was predominant in the gastrointestinal tract and was related to Nicotinamide.
  
  
  RESULTS
  The median survival time (M.S.T.) was 10 months, as reported by others authors with conventional treatment, but in patients without surgical residual tumor and submitted to the complete treatment schedule, the survival at 35 months was around 25%.
  
  
  CONCLUSIONS
  We conclude that this method is feasible with acceptable toxicity; analyzing the survival curves appears to be a trend towards an improvement in survival in the subgroup of patients with gross total removal treated with the combination of Carbogen, Nicotinamide, and accelerated fractionation.
authors.affiliation: Cattedra di Radioterapia, Universita di Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Fatigante
authors.forename: F
authors.initials: F
authors.lastname: Ducci
authors.forename: F
authors.initials: F
authors.lastname: Cartei
authors.forename: S
authors.initials: S
authors.lastname: Colosimo
authors.forename: C
authors.initials: C
authors.lastname: Marini
authors.forename: R
authors.initials: R
authors.lastname: Prediletto
authors.forename: R
authors.initials: R
authors.lastname: Danesi
authors.forename: M
authors.initials: M
authors.lastname: Laddaga
authors.forename: M
authors.initials: M
authors.lastname: Del Tacca
authors.forename: P
authors.initials: P
authors.lastname: Caciagli
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D010100:Oxygen / Q000627:therapeutic use*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D015173:Supratentorial Neoplasms / Q000097:blood / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate
chemical_list: D011838:Radiation-Sensitizing Agents; D002245:Carbon Dioxide; D009536:Niacinamide; C011700:carbogen; D010100:Oxygen