Hyperfractionated radiotherapy and multi-agent chemotherapy (procarbazine, ACNU and vincristine) for high-grade gliomas: a prospective study.
OBJECTIVE
To evaluate the feasibility, efficacy and toxicity of hyperfractionated radiotherapy and multi-agent chemotherapy, including procarbazine, nimustine (ACNU) and vincristine, in adults with high-grade gliomas.


METHODS
Radiotherapy was administered using two fractions per day of 1.2 Gy to a total dose of 72 Gy. The chemotherapy consisted of procarbazine (90 mg/m2 orally, days 1 to 14), ACNU (80 mg/m2 intravenously, day 1) and vincristine (0.5 mg/m2 intravenously, days 1 and 8) and was administered during and after radiotherapy, up to a maximum of four courses.


RESULTS
From September 1997 to August 1999, a total of ten patients (five with glioblastoma and five with grade 3 gliomas) were enrolled. All ten patients were able to complete a total dose of 72 Gy hyperfractionated radiotherapy with one course of concurrent chemotherapy. Of eight assessable patients, three (38%) had an objective response, comprising two CR and one PR. The median time to progression was 10.7 months and the median survival time of all patients was 15.0 months. Although grade 4 leukopenia and grade 4 thrombocytopenia occurred in 10% and 10% of all patients, respectively, these were transient and no patients developed neutropenic fever or intracranial hemorrhage. No serious non-hematological or late toxicities occurred.


CONCLUSIONS
Hyperfractionated radiotherapy and multi-agent chemotherapy using procarbazine, ACNU and vincristine is safe and well tolerated for high-grade gliomas.
Ogawa
Kazuhiko
K
Department of Radiology, University of the Ryukyus, School of Medicine, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan. kogawa@med.u-ryukyu.ac.jp
Yoshii
Yoshihiko
Y
Toita
Takafumi
T
Saito
Atsushi
A
Kakinohana
Yasumasa
Y
Iraha
Shiro
S
Sugimoto
Koichi
K
Tsuchida
Yukihiro
Y
Tamaki
Wakana
W
Adachi
Genki
G
Hyodo
Akio
A
Murayama
Sadayuki
S
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001254:Astrocytoma / Q000188:drug therapy / Q000532:radiotherapy; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015376:Nimustine / Q000008:administration & dosage / Q000009:adverse effects; D009837:Oligodendroglioma / Q000188:drug therapy / Q000532:radiotherapy; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D015173:Supratentorial Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D015376:Nimustine; D011344:Procarbazine; D014750:Vincristine