title: A phase II study of radiotherapy after hyperbaric oxygenation combined with interferon-beta and nimustine hydrochloride to treat supratentorial malignant gliomas.
abstract: Hypoxic cells play a key role in the radioresistance of malignant glioma. Interferon-beta, ACNU as nimustine hydrochloride and radiotherapy (IAR) is a common therapy for malignant glioma in Japan. Since hyperbaric oxygenation (HBO) increases oxygen pressure in glioma tissue, we applied a modified IAR therapy, radiotherapy after HBO combined with interferon-beta and ACNU (HBO/IAR therapy), for supratentorial malignant gliomas. Daily radiation therapy was completed within 15 min after HBO. We assessed HBO/IAR with respect to toxicity, response rates and the time of tumor progression (TTP). We also examined the incidence of responses by some prognostic factors before HBO/IAR, namely, age, Karnofsky performance scale (KPS), histological type, tumor size, tumor site and operation type. Of 39 patients who participated in this study, 35 underwent a complete schedule of HBO/IAR therapy in which toxicity was permissible. Thirty patients (76.9%) either maintained or increased KPS during HBO/IAR with a mean duration of 68 +/- 14 days. The response rates (CR + PR%) for glioblastoma, anaplastic astrocytoma and overall were 50%, 30% and 43%, respectively. The incidence of therapeutic responses among all prognostic factors before HBO/IAR did not significantly differ. Median TTP for patients with glioblastoma, patients with anaplastic astrocytoma, and overall were 38, 56 and 43 weeks, respectively. The present study suggested that HBO/IAR therapy could be applied to especially patients with poor prognostic factors, because of its short treatment period, its permissible toxicity and identical response to patients with good prognostic factors.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan. tbeppu@iwate-med.ac.jp
authors.forename: Takaaki
authors.initials: T
authors.lastname: Beppu
authors.forename: Katsura
authors.initials: K
authors.lastname: Kamada
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nakamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Oikawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Takeda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arai
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D016899:Interferon-beta / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D015376:Nimustine / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D015996:Survival Rate
chemical_list: D015376:Nimustine; D016899:Interferon-beta