title: Combination chemotherapy with carmustine and cisplatin followed by procarbazine, lomustine, and vincristine for adult high-grade astrocytoma.
abstract: BACKGROUND
  We have reported that carmustine (BCNU) and cisplatin administered before, during, and after radiotherapy did not improve the survival of patients with high-grade astrocytomas and were associated with more serious toxicities than radiotherapy plus BCNU. In an attempt to improve survival, we studied a combination regimen procarbazine, lomustine, and vincristine (PCV) after radiotherapy in addition to BCNU and cisplatin during radiotherapy.
  
  
  METHODS
  From 1994 through 1998, 42 patients were enrolled in the study. Of these, 20 had glioblastoma multiforme and 22 had anaplastic astrocytoma. The patients had a median age of 48.5 years. All patients had subtotal or total resection, or biopsy as the initial procedure. Then, all patients were treated with BCNU and cisplatin concurrently during radiotherapy followed by PCV after radiotherapy.
  
  
  RESULTS
  The median time to follow up for survivors was 13.8 months (range, 1.7-108.2 months). The median time to tumor progression was 7.2 months (range, 0-88.7 months) and median survival time was 13.3 months (range, 1.7-88.7 months). The only factor that had a conventionally significant effect on the overall survival was resectability. Patients who had received subtotal/total resection had a longer median survival compared with patients who had received biopsy only (18.0 vs. 9.5 months). This combined modality treatment program was associated with reversible grade 3 to 4 hematological toxicity in 10 patients, with grade 3 ototoxicity in one patient and grade 2 neurotoxicity in one patient.
  
  
  CONCLUSIONS
  A combination of BCNU and cisplatin with cranial irradiation followed by PCV was moderately toxic and appeared to offer no obvious survival advantages compared with radiotherapy plus BCNU and cisplatin alone.
authors.affiliation: Division of Hematology Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei. gerson@ms2.hinet.net
authors.forename: Chi-Ting
authors.initials: CT
authors.lastname: Liau
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wei
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001254:Astrocytoma / Q000188:drug therapy*; D001932:Brain Neoplasms / Q000188:drug therapy*; D002330:Carmustine / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011344:Procarbazine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D011344:Procarbazine; D014750:Vincristine; D008130:Lomustine; D002945:Cisplatin; D002330:Carmustine