Preradiation chemotherapy with ACNU-CDDP in patients with newly diagnosed glioblastoma: a retrospective analysis.
OBJECTIVE
We evaluated the benefit of preradiation chemotherapy with ACNU (nimustine) and CDDP (cisplatin) in patients with newly diagnosed glioblastoma by retrospective analysis.


METHODS
A total of 151 patients were newly confirmed to have glioblastoma between January 2000 and December 2004. All patients underwent surgical resection: 38 (25.2%) patients underwent complete resection, 73 (48.3%) underwent incomplete resection and 40 (26.5%) underwent biopsy. Preradiation chemotherapy using ACNU-CDDP was administered as an initial adjuvant therapy for 87 (57.6%) patients (ACNU-CDDP group), radiation therapy was performed in 31 (20.5%) patients (RT group) and the remaining 33 (21.9%) patients were treated with other regimens or refused to undergo further treatment.


RESULTS
The median survival time was 13 months (95% CI 11.29-14.71), and the overall survival rate was 54.0% at 1 year and 21.3% at 2 years. The differences in median survival time between the complete resection group and biopsy group and between the ACNU-CDDP group and RT group were significant (15.0 vs. 10 months, p = 0.028, and 16.0 vs. 12.0 months, p = 0.036, respectively) in the univariate analyses. Even in the multivariate analysis, preradiation chemotherapy using ACNU-CDDP had a significant effect on survival prolongation (HR = 0.628, p = 0.042). The usage of temozolomide for adjuvant or salvage therapy also had an independent and significantly positive effect on survival (HR = 0.511, p = 0.006). Grade 3 and 4 hematologic toxicities occurred in 28 (32.1%) patients in the ACNU-CDDP group, but there were no treatment-related deaths.


CONCLUSIONS
Preradiation chemotherapy with ACNU-CDDP as an initial therapy for patients with newly diagnosed glioblastoma is feasible and should be assessed in a randomized phase III study.
Han
Jung Ho
JH
Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. hwnjung@snu.ac.kr
Park
Chul-Kee
CK
Lee
Se-Hoon
SH
Kim
Chae-Yong
CY
Kim
Dong-Wan
DW
Paek
Sun Ha
SH
Kim
Dong Gyu
DG
Heo
Dae Seog
DS
Kim
Il Han
IH
Jung
Hee-Won
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015376:Nimustine / Q000627:therapeutic use*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D000077204:Temozolomide
D015376:Nimustine; D003606:Dacarbazine; D002945:Cisplatin; D000077204:Temozolomide