title: Radiation therapy and hydroxyurea followed by the combination of 6-thioguanine and BCNU for the treatment of primary malignant brain tumors.
abstract: OBJECTIVE
  This study was designed to evaluate a combined modality treatment for malignant gliomas using radiation therapy with a radiosensitizer and an adjuvant chemotherapy regimen designed to modify resistance to BNCU.
  
  
  METHODS
  Patients were eligible if they were 15 years of age or older, and had newly diagnosed glioblastoma multiforme (GBM), or anaplastic glioma (AG). Treatment consisted of external beam radiotherapy given to a dose of 60 Gy using a single daily fraction Monday to Friday. Concurrent hydroxyurea at a dose of 300 mg/m2 every 6 h every other day was given during radiation. Following radiotherapy, patients were then treated with BCNU and 6-Thioguanine (6TG). The 6-TG was given by mouth every 6 h for 12 doses prior to BCNU. Patients were initially treated with 60 mg/m2/dose of 6TG, with escalation to a maximum dose of 100 mg/m2/dose. The primary study end points were time to tumor progression and survival.
  
  
  RESULTS
  A total of 245 eligible patients were enrolled from 1/18/88 to 12/26/91. The histologic subtypes included 135 GBM, and 110 with AG (103 with anaplastic astrocytoma, 7 with high-grade mixed oligoastrocytoma). For the GBM group, the median time to tumor progression (TTP) and median survival were 33 (95% CI 26, 39) and 56 (95% CI 49, 69) weeks, respectively. For the AG group the median TTP was 282 weeks (95% lower confidence bound = 155 weeks). Median survival for this group has not been reached (95% lower confidence bound = 284 weeks) with a median follow-up for surviving patients of 298 weeks. A proportional hazards model was used to look at potential prognostic factors for survival, including initial Karnofsky Performance Scale (KPS), age, and extent of surgery, as well as dose of 6TG. Higher KPS, and lower age, predicted for longer survival (p < 0.01, < 0.001) in GBM patients; lower age was significant (p = 0.05) for AG cases. A higher (greater than 95 mg/m2) or lower dose of 6TG was not statistically significant in this model.
  
  
  CONCLUSIONS
  This therapy was no more effective in patients with GBM than other reported series. In patients with malignant gliomas other than GBM, prolonged progression-free and overall survival is noted, without a median survival reached at the time of this report. In this subset of AG patients, survival is comparable to recent studies using halogenated prymidines during radiation and Procarbazine, CCNU, and Vincristine (PCV) as adjuvant chemotherapy.
authors.affiliation: Department of Neurosurgery, University of California San Francisco, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Prados
authors.forename: D A
authors.initials: DA
authors.lastname: Larson
authors.forename: K
authors.initials: K
authors.lastname: Lamborn
authors.forename: M W
authors.initials: MW
authors.lastname: McDermott
authors.forename: P K
authors.initials: PK
authors.lastname: Sneed
authors.forename: W M
authors.initials: WM
authors.lastname: Wara
authors.forename: S M
authors.initials: SM
authors.lastname: Chang
authors.forename: E E
authors.initials: EE
authors.lastname: Mack
authors.forename: H G
authors.initials: HG
authors.lastname: Krouwer
authors.forename: K L
authors.initials: KL
authors.lastname: Chandler
authors.forename: R E
authors.initials: RE
authors.lastname: Warnick
authors.forename: R L
authors.initials: RL
authors.lastname: Davis
authors.forename: J E
authors.initials: JE
authors.lastname: Rabbitt
authors.forename: M
authors.initials: M
authors.lastname: Malec
authors.forename: V A
authors.initials: VA
authors.lastname: Levin
authors.forename: P H
authors.initials: PH
authors.lastname: Gutin
authors.forename: T L
authors.initials: TL
authors.lastname: Phillips
authors.forename: C B
authors.initials: CB
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D002330:Carmustine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy / Q000532:radiotherapy; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013866:Thioguanine / Q000008:administration & dosage
chemical_list: D013866:Thioguanine; D002330:Carmustine; D006918:Hydroxyurea