title: Safety of thrice-daily hyperfractionated radiation and BCNU for high-grade gliomas.
abstract: OBJECTIVE
  To investigate the safety of thrice-daily hyperfractionated radiotherapy (RT) given in conjunction with BCNU (carmustine) in high-grade gliomas.
  
  
  METHODS
  Patients >18 years old with newly diagnosed high-grade gliomas were eligible. The dose of radiation was 5040 cGy, with a 1440-cGy boost in 180 cGy fractions delivered thrice daily in two 6-day periods with a 2-week interval. BCNU (200 mg/m(2)) was administered on the first day of radiation, then every 7 weeks for 1 year and every 10 weeks for another year.
  
  
  RESULTS
  Eighteen patients were enrolled. The mean age was 49.6 years. Sixteen patients had astrocytomas (Grade 3 or 4 in 5 and 11 patients, respectively) and 2 had oligoastrocytomas (Grade 3 and 4 in 1 patient each). One underwent total resection, 9 subtotal resection, and 8 biopsy only. Thirteen patients had stable disease, 4 regression, and 1 progression. The median time to progression was 37.8 weeks. The median overall survival was 44.4 weeks. Nine patients had neurologic toxicities, including 2 deaths at 69 and 139 weeks.
  
  
  CONCLUSIONS
  This regimen is unacceptably toxic. Factors that could have contributed to the toxicity may include the total radiation dose, thrice-daily hyperfractionation, and the concurrent use of i.v. BCNU.
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Ravi D
authors.initials: RD
authors.lastname: Rao
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Thomé
authors.forename: Judith
authors.initials: J
authors.lastname: O'Fallon
authors.forename: John D
authors.initials: JD
authors.lastname: Earle
authors.forename: Robert P
authors.initials: RP
authors.lastname: Dinapoli
authors.forename: Jan C
authors.initials: JC
authors.lastname: Buckner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D001254:Astrocytoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D001927:Brain Diseases / Q000209:etiology; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004334:Drug Administration Schedule; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018316:Gliosarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D002330:Carmustine