First-line nitrosourea-based chemotherapy in symptomatic non-resectable supratentorial pure low-grade astrocytomas.
At the present time, there are no proven beneficial effects of chemotherapy (CT) for the treatment of pure low-grade astrocytomas. Brain radiotherapy (RT) still remains the standard treatment in order to reduce or delay tumor progression or symptoms, despite possible long-term neurologic complications. We report 10 patients, with histologically proven pure low-grade fibrillary astrocytomas, to which we administered a first-line nitrosourea-based CT. All patients were symptomatic with pharmaco-resistant epilepsy or neurologic symptoms, and had been rejected for neurosurgical resection. All patients with epilepsy had a clinical improvement with reduction in seizure frequency and 60% became seizure-free. CT was well tolerated; all patients developed myelosuppression with 40% of grade III/IV hematotoxicity. Seven were alive at the time of writing with a mean follow-up of 6.5 years (3.5-12) from first recorded symptoms. The three deceased patients died 7.5, 7.5, and 8.5 years from first symptoms. These results demonstrate that some patients with symptomatic non-resectable fibrillary low-grade astrocytomas can be treated with up-front CT to improve their neurologic status. This report suggests that benefits of CT on symptoms, survival, and quality of life should be prospectively compared with RT.
Frenay
M P
MP
Service de Neurologie, Hôpital Pasteur, Nice, France.
Fontaine
D
D
Vandenbos
F
F
Lebrun
C
C
D000328:Adult; D001254:Astrocytoma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology; D003131:Combined Modality Therapy; D004358:Drug Therapy / Q000379:methods*; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000627:therapeutic use*; D012189:Retrospective Studies
D009607:Nitrosourea Compounds