title: Efficacy and feasibility of procarbazine, ranimustine and vincristine chemotherapy, and the role of surgical resection in anaplastic oligodendroglioma.
abstract: The safety, tolerance and preliminary efficacy of a chemotherapy regimen consisting of procarbazine (PCB), ranimustine (MCNU) and vincristine (VCR) were assessed for patients with newly diagnosed supratentorial anaplastic oligodendroglioma.
  
  
  METHODS
  Between October 1999 and September 2003, 5 patients were enrolled. The initial regimens were prescribed as adjuvant therapy in conjunction with radiotherapy following standard surgical treatment. All patients received a chemotherapy comprising ranimustine (100 mg/m2) intravenously on Day 1, procarbazine (60 mg/m2) on Days 8 to 21, and vincristine (1.4 mg/m2, maximum total 2 mg) on Days 8 and 29. The cycles were repeated every 8 weeks until tumor progression was evident, or for a total of 6 cycles over a 1-year period. The primary end-points were safety and tolerability, while the secondary end-point was overall survival.
  
  
  RESULTS
  Five consecutive eligible patients were treated. Of the 4 evaluable patients, 3 partially responded to the treatment (PR), while 1 had a complete response (CR): all patients are still alive. However, 3 of the 5 patients showed relapse, with a time to tumor progression (TTP) of 50, 143 and 241 weeks, respectively. Two of these patients received combined treatment with carboplatin, etoposide and recombinant human mutant tumor necrosis factor-alpha at the first relapse. This regimen appeared to be safe and neither neurological toxicity, severe or life-threatening hematological toxicity, nor fatal toxicity (WHO Grade 4) were experienced.
  
  
  CONCLUSIONS
  These results suggest that a chemotherapy regimen consisting of PCB, MCNU and VCR in this patient population seems to be safe and tolerable, and the response rate was high. Thus, wide resection with a risk of major neurological morbidity due to nearby functionally critical areas can be avoided. However, since the relapse rate was high, a second-line chemotherapy should be developed for anaplastic oligodendroglioma to improve the long-term control of the disease.
authors.affiliation: Department of Neurosurgery, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan. masaaki@fukuoka-u.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwaasa
authors.forename: Masani
authors.initials: M
authors.lastname: Nonaka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsugu
authors.forename: Kazuki
authors.initials: K
authors.lastname: Nabeshima
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000008:administration & dosage / Q000009:adverse effects; D009837:Oligodendroglioma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery*; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D009607:Nitrosourea Compounds; D011344:Procarbazine; D014750:Vincristine; C020766:ranimustine