Treatment of Newly Diagnosed Glioblastoma Multiforme with Carmustine, Cisplatin and Etoposide Followed by Radiotherapy. A Phase II Study
Treatment of Newly Diagnosed Glioblastoma Multiforme with Carmustine, Cisplatin and Etoposide Followed by Radiotherapy. A Phase II Study
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DOI：
10.1023/a:1006254716877
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发表时间：
1999-06
影响因子：
3.9
通讯作者：
U. Lassen;P. Kristjansen;A. Wagner;M. Kosteljanetz;H. Poulsen
中科院分区：
文献类型：
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作者：
U. Lassen;P. Kristjansen;A. Wagner;M. Kosteljanetz;H. Poulsen
对III级和IV级胶质瘤患者的荟萃分析和几项研究表明，在手术和放疗基础上增加亚硝基脲化疗可能会提高生存率。我们进行了一项II期研究的放疗前化疗与卡氮芥，顺铂和足叶乙甙。BCNU 200 mg/m ~ 2静脉滴注第1天，顺铂20 mg/m ~ 2静脉滴注第1-5天，足叶乙甙（VP-16）100 mg/m ~ 2静脉滴注第1 - 5天，每5周1次，3个周期后局部照射60戈伊，分30次。29例初治多形性胶质母细胞瘤（GBM）患者，平均年龄50岁（27-66岁），体能状态（PS）0-2，按Macdonald标准，化疗后部分缓解（PR）33%，稳定（SD）41%，进展（PD）26%。在额外的放射治疗后，44%有PR，37% SD和19% PD。非血液学毒性和白细胞减少症轻微，但血小板减少症（TP）频繁。III级和IV级TP发生率分别为25%和57%，III级出血发生率为45%。未观察到严重或致死性并发症。中位疾病进展时间（TTP）为7.6个月（6.0-9.1），中位生存期为11.4个月（10.1-12.7）。短疗程放疗前化疗可能比辅助化疗更简单，并且该方案在III级胶质瘤中可能更有效。
A meta-analysis and several studies of patients with grade III and IV gliomas have indicated that the addition of nitrosurea based chemotherapy to surgery and radiation may improve survival. We performed a phase II study of pre-irradiative chemotherapy with BCNU, cisplatin and etoposide. This implies a short total treatment duration and a reliable response evaluation.The treatment schedule was three cycles of BCNU 200 mg/m2i.v. on day 1, cisplatin 20 mg/m2i.v. on day 1–5 and etoposide (VP-16) 100 mg/m2i.v. on day 1–5, given every five weeks and followed by localized radiation, 60 Gy in 30 fractions. Twenty-nine patients with newly diagnosed glioblastoma multiforme (GBM), mean age 50 (27–66) and performance status (PS) 0–2 were included.Using the Macdonald criteria 33% had partial remission (PR), 41% stable disease (SD) and 26% progressive disease (PD) after chemotherapy. After additional radiation 44% had PR, 37% SD and 19% PD. Non-hematological toxicity and leukopenia was mild, but thrombocytopenia (TP) frequent. Grade III and IV TP occurred in 25% and 57% respectively, and grade III bleeding in 45%. No severe or fatal complications was seen. Median time to progression (TTP) was 7.6 months (6.0–9.1) and median survival was 11.4 months (10.1–12.7).We conclude that this regimen is effective and feasible in patients with GBM. The short course pre-irradiatory chemotherapy may be less cumbersome than adjuvant chemotherapy and the regimen may be even more active in grade III gliomas.