Advertisement

Chemoradiation Strategies for Patients with Malignant Gliomas

  • Heather A. Curry
  • Walter J. CurranJr.
Part of the Cancer Drug Discovery and Development book series (CDD&D)

Abstract

Malignant glioma afflicts approx 10,000 patients per year in North America. Since the publication of the Brain Tumor Study Group (BTSG) 6901 study results in the late 1970s, the standard management of patients with malignant glioma has been maximal surgical resection without compromise of neurologic function, followed by postoperative cranial radiation therapy (RT) to 60 Gy with or without nitrosourea-based therapy (1). The term malignant glioma includes a heterogeneous group of tumors including anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), anaplastic oligodendroglioma (AO), anaplastic mixed tumors, and malignant glioma not otherwise specified. These histologies are associated with different responses to chemotherapy and radiation therapy (RT) as well as different natural histories and survival expectations. Typical median survival times (MSTs) with therapy for patients with GBM and AA with standard therapeutic approaches are 10–12 mo and 30–40 mo, respectively (2). Genetic characteristics of primary brain tumors have been correlated with treatment response and clinical outcomes as shown by Cairncross et al., who demonstrated that allelic loss of chromosome 1p predicted increased response to chemotherapy and longer survival (3). Despite improvements in operative and perioperative management, radiotherapeutic techniques, and supportive measures, little progress has been made in prolonging survival for the majority of patients with malignant glioma. The purpose of this chapter is to review the literature on the combined modality treatment of patients with malignant glioma, focusing on the data from prospective randomized trials, and to briefly discuss future directions in research to improve outcome for patients affected by this disease.

Keywords

Malignant Glioma Radiat Oncol Biol Phys Radiation Therapy Oncology Group Recursive Partitioning Analysis Anaplastic Glioma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Walker MD, Alexander E, Hunt WE, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. J Neurosurg 1978; 49: 333–343.PubMedCrossRefGoogle Scholar
  2. 2.
    Curran WJ, Scott CB, Horton J, et al. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 1993; 85: 704–710.PubMedCrossRefGoogle Scholar
  3. 3.
    Cairncross JG, Ueki K, Zlatescu MC, et al. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. JNatl Cancer Inst 1998; 90: 1473–1479.CrossRefGoogle Scholar
  4. 4.
    Kristiansen K, Hagen S, Kollevold T, et al. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer 1981; 47: 649–652.PubMedCrossRefGoogle Scholar
  5. 5.
    Walker MD, Green SB, Byar DP, et al. Randomized comparisons of radiotherapy and nitrosureas for the treatment of malignant glioma after surgery. N Engl J Med 1980; 303: 1323–1329.PubMedCrossRefGoogle Scholar
  6. 6.
    Green SB, Byar DP, Walker MD, et al. Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma. Cancer Treat Rep 1983; 67: 121–132.PubMedGoogle Scholar
  7. 7.
    Shapiro WR, Green SB, Burger PC, et al. Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant glioma. J Neurosurg 1989; 71: 1–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Fine HA, Dear KBG, Loeffler JS, Black PM, Canellos GP. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. Cancer 1993; 71: 2585–2597.PubMedCrossRefGoogle Scholar
  9. 9.
    Stewart LA, Burdett S, Souhami RL. Chemotherapy in high-grade glioma: a meta-analysis using individual patient data from randomized clinical trials (RCTS). Pro Am Soc Clin Oncol 2000; 19: 168.Google Scholar
  10. 10.
    Lands SH, Murray T, Bolden S. Cancer Statistics. J Am Canc Soc 1998; 48: 6–29.Google Scholar
  11. 11.
    Prados MD, Scott C, Curran WJ, et al. Procarbazine, lomustine and vincristine (PCV) chemotherapy for anaplastic astrocytoma: a retrospective review of Radiation Therapy Oncology Group Protocols comparing survival with carmustine or PCV adjuvant chemotherapy. J Clin Oncol 1999; 17: 3389–3395.PubMedGoogle Scholar
  12. 12.
    Kowalczuk A, Macdonald RL, Amidei C, et al. Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. Neurosurgery 1997; 41: 1028–1036.PubMedCrossRefGoogle Scholar
  13. 13.
    Ciric I, Ammirati M, Vick N, Mikhael M. Supratentorial gliomas: surgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurg 1987; 21: 21–26.CrossRefGoogle Scholar
  14. 14.
    Winger MJ, Macdonald DR, Cairncross JG. Supratentorial anaplastic gliomas in adults: The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 1989; 71: 487–493.PubMedCrossRefGoogle Scholar
  15. 15.
    Curran WJ Jr, Scott CB, Horton J, et al. Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report of 3 Radiation Therapy Oncology Group trials. J Neurooncol 1992; 12: 219–227.PubMedCrossRefGoogle Scholar
  16. 16.
    Prados MD, Gutin PH, Phillips TL, et al. Highly anaplastic astrocytoma: a review of 357 patients treated between 1977 and 1989. Int J Oncol Biol Phys 1992; 23: 3–8.CrossRefGoogle Scholar
  17. 17.
    Levin VA, Silver P, Hannigan J, et al. Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine, (PCV) over BCNU for anaplastic gliomas: NCOG 6G61 final report. Int J Oncol Biol Phys 1990; 18: 321–324.CrossRefGoogle Scholar
  18. 18.
    Brada M, Thomas DGT, Bleehan NM. Medical Research Council (MRC) randomized trial of adjuvant chemotherapy in high grade glioma (HGG). Proc Am Soc Clin Oncol 1998; 17: 400.Google Scholar
  19. 19.
    Prados MD, Scott CS, Curran WJ, et al. Procarbazine, lomustine and vincristine (PCV) chemotherapy for anaplastic astrocytoma: a retrospective review of Radiation Therapy Oncology Group protocols comparing survival with carmustine or PCV adjuvant chemotherapy. J Clin Oncol 1999; 17: 3389–3395.PubMedGoogle Scholar
  20. 20.
    Donahue B, Scott CB, Nelson JS, et al. Influence of an oligodendroglial component on the survival of patients with anaplastic astrocytomas: A report of Radiation Therapy Oncology Group 83–02. Int J Radiat Oncol Biol Phys 1997; 38: 911–914.PubMedCrossRefGoogle Scholar
  21. 21.
    Smith JS, Perry A, Bore11 TJ, et al. Alterations of chromosome arms 1p and 19q as predictors of survival in oligodendrogliomas, astrocytomas, and mixed oligoastrocytomas. J Clin Oncol 2000; 18: 636–645.PubMedGoogle Scholar
  22. 22.
    Cairncross G, Macdonald D, Ludwin S, et al. Chemotherapy for anaplastic oligodendroglioma. J Clin Oncol 1994; 12: 2013–2017.PubMedGoogle Scholar
  23. 23.
    Kyritsis AP, Yung WK, Bruner J, Gleason MI, Levin VA. The treatment of anaplastic oligodendrogliomas and mixed gliomas. Neurosurgery 1993; 32: 365–371.PubMedCrossRefGoogle Scholar
  24. 24.
    Kirby S, Macdonald D, Fisher B, Gaspar L, Cairncross G. Pre-radiation chemotherapy for malignant gliomas in adults. Can J Neurol Sci 1996; 23: 123–127.PubMedGoogle Scholar
  25. 25.
    Kim L, Hochberg FH, Thornton AF, et al. Procarbazine, lomustine and vincristine (PCV) chemotherapy for grade II and grade IV oligoastrocytoma. J Neurosurg 1996; 85: 602–607.PubMedCrossRefGoogle Scholar
  26. 26.
    Boiardi A, Silvani A, Pozzi A, et al. Advantage of treating anaplastic gliomas with aggressive protocol combining chemotherapy and radiotherapy. J Neurooncol 1997; 34: 179–185.PubMedCrossRefGoogle Scholar
  27. 27.
    Jeremic B, Shibamoto Y, Gruijicic D, et al. Combined treatment modality for anaplastic oligodendroglioma: a phase II study. J Neurooncol 1999; 43: 179–185.PubMedCrossRefGoogle Scholar
  28. 28.
    Walker MD, Strike TA, Sheline GE. An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 1979; 5: 1725–1731.PubMedCrossRefGoogle Scholar
  29. 29.
    Chang CH, Horton J, Schoenfeld D, et al. Comparison of post operative radiotherapy in combined post operative radiotherapy and chemotherapy in the multidisciplinary management of malignant gliomas. The Joint Radiation Therapy Oncology Group & The Eastern Cooperative Oncology Group study. Cancer 1983; 32: 997–1007.CrossRefGoogle Scholar
  30. 30.
    Halperin EC, Burger PC, Bullard DE. The fallacy of the localized supratentorial malignant glioma. Int J Oncol Biol Phys 1988; 15: 505–508.CrossRefGoogle Scholar
  31. 31.
    Kelly P, Daumas-Duport C, Kispert D, Imaging-based stereotactic biopsies in untreated intracranial glioneoplasm. J Neurosurgery 1987; 66: 865–875.CrossRefGoogle Scholar
  32. 32.
    Wallner KE, Galicich JH, Krol G, Arbit E, Malkin MG. Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Oncol Biol Phys 1989; 16: 1405.CrossRefGoogle Scholar
  33. 33.
    Marks JE, Wong J. The risk of cerebral radionecrosis in relation to dose, time and fractionation. Prog Exp Tumor Res 1985; 29: 210–218.PubMedGoogle Scholar
  34. 34.
    Gutin PH, Prados MD, Phillips TL, et al. External irradiation followed by an interstitial high activity iodine-125 implant “boost” in the initial treatment of malignant gliomas: NCOG study 6G-82–2. Mt J Oncol Biol Phys 1991; 21: 601–606.CrossRefGoogle Scholar
  35. 35.
    Sneed PK, McDermott MW, Gutin PH. Interstitial brachytherapy procedures for brain tumors. Semin Surg Oncol 1997; 13: 157–166.PubMedCrossRefGoogle Scholar
  36. 36.
    Payne DG, Simpson WJ, Keen C, Platts ME. Malignant astrocytoma: hyperfractionated and standard radiotherapy with chemotherapy in a randomized prospective clinical trial. Cancer 1982; 50: 2301–2306.PubMedCrossRefGoogle Scholar
  37. 37.
    Shin KH, Muller PH, Geggie PHS. Superfractionation radiation therapy in the treatment of malignant astrocytoma. Cancer 1983; 52: 2040–2043.PubMedCrossRefGoogle Scholar
  38. 38.
    Fulton DS, Urtasun RC, Shin KH, et al. Misonidazole combined with hyperfractionation in the management of malignant glioma. Int J Radiat Oncol Biol Phys 1984; 10: 1709–1712.PubMedCrossRefGoogle Scholar
  39. 39.
    Werner-Wasik M, Scott CB, Nelson DF, et al. Final report of a Phase I/II trial of hyperfractionated radiation therapy with carmustine for adults with supratentorial malignant gliomas: Radiation Therapy Oncology Group study 83–02. Cancer 1996; 77: 1535–1543.PubMedCrossRefGoogle Scholar
  40. 40.
    Stewart DJ, Grahovac Z, Hugenholtz H, et al. Feasibility study of intraarterial vs intravenous cisplatin, BCNU, and teniposide combined with systemic cisplatin, teniposide, cytosine arabinoside, glycerol and mannitol in the treatment of primary and metastatic brain tumors. J Neurooncol 1993; 17 (1): 71–79.PubMedCrossRefGoogle Scholar
  41. 41.
    Kleinschmidt-DeMasters BK, Geier JM. Pathology of high-dose intraarterial BCNU. Surg Neurol 1989; 31 (6): 435–443.PubMedCrossRefGoogle Scholar
  42. 42.
    Stewart DJ, Grahovac Z, Hugenholtz H, Russell N, Richard M, Benoit B. Combined intraarterial and systemic chemotherapy for intracerebral tumors. Neurosurgery 1987; 2: 207–214.CrossRefGoogle Scholar
  43. 43.
    Stewart DJ, Grahovac Z, Benoit B, et al. Intracarotid chemotherapy with a combination of 1,3-bis(2chloroethyl)- 1-nitrosourea (BCNU), cis-diaminedichloroplatinum (cisplatin), and 4’-O-demethyl-l-O(4,6-O-2-thenylidene-beta-D-glucopyranosyl) epipodophyllotoxin (VM-26) in the treatment of primary and metastatic brain tumors. Neurosurgery 1984; 15 (6): 828–833.PubMedCrossRefGoogle Scholar
  44. 44.
    Feun LG, Wallace S, Yung WK, et al. Phase-I trial of intracarotid BCNU and cisplatin in patients with malignant intracerebral tumors. Cancer Drug Deliv 1984; 1 (3): 239–245.PubMedCrossRefGoogle Scholar
  45. 45.
    West CR, Avellanosa AM, Barua NR, Patel A, Hong CI. Intraarterial 1,3-bis(2-chloroethyl)-1nitrosourea (BCNU) and systemic chemotherapy for malignant gliomas: a follow-up study. Neurosurgery 1983; 13 (4): 420–426.PubMedCrossRefGoogle Scholar
  46. 46.
    Lehane DE, Bryan RN, Horowitz B, et al. Intraarterial cis-platinum chemotherapy for patients with primary and metastatic brain tumors. Cancer Drug Deliv 1983; 1 (1): 69–77.PubMedCrossRefGoogle Scholar
  47. 47.
    Prados MD, Scott C, Sandler H, et al. A phase 3 randomized study of radiotherapy plus procarbazine, CCNU, and vincristine (PCV) with or without BUdR for the treatment of anaplastic astrocytoma: a preliminary report of RTOG 9404. Int J Radiat Oncol Biol Phys 1999; 45: 1109–1115.PubMedCrossRefGoogle Scholar
  48. 48.
    Del Rowe J, Scott C, Werner-Wasik M, et al. A single-arm open label phase II study of intravenously administered tirapazamine plus radiation therapy for glioblastoma multiforme. J Clin Oncol 2000; 18 (6): 1254–1259.PubMedGoogle Scholar
  49. 49.
    Langer CJ, Ruffer J, Rhodes H, et al. Phase II Radiation Therapy Oncology Group trial of weekly paclitaxel and conventional external beam radiation therapy for supratentorial glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2001; 51: 113–119.PubMedCrossRefGoogle Scholar
  50. 50.
    MacDonald D. A Phase I study of Topotecan plus cranial radiation for glioblastoma multiforme: a report of Radiation Therapy Oncology Group (RTOG) study 95–07. Proc Am Soc Thera Rad Oncol. Int JRadiat Oncol Biol Phys 1997; 39: 271.CrossRefGoogle Scholar
  51. 51.
    Patel M, McCully C, Godwin K. Plasma and cerebrospinal fluid pharmacokinetics of temozolomide. Proc Am Soc Clin Oncol 1995; 14: 461 (abstr 1485).Google Scholar
  52. 52.
    Newlands ES, O’Reilly SM, Glaser MG, et al. The Charing Cross Hospital experience with temozolomide in patients with gliomas. Eur J Cancer 1996; 32A: 2236–2241.CrossRefGoogle Scholar
  53. 53.
    Bower M, Newlands ES, Bleehen NM, et al. Multicentre CRC phase II trial of temozolomide in recurrent or progressive high grade glioma. Cancer Chemother Pharmacol 1997; 40: 484–488.PubMedCrossRefGoogle Scholar
  54. 54.
    Yung WKA. Temozolomide in malignant gliomas. Semin Oncol 2000; 27 (Suppl 6): 27–34.PubMedGoogle Scholar
  55. 55.
    Friedman HS, McLendon RE, Kerby T, et al. DNA mismatch repair and 06-alkylguanine-DNA alkyltransferase analysis and response to Temodal in newly diagnosed malignant glioma. J Clin Oncol 1998; 16: 3851–3857.PubMedGoogle Scholar
  56. 56.
    Stupp R, Maillard I, Pica A. Daily temozolomide (TMZ) and concomitant radiotherapy followed by adjuvant TMZ for newly diagnosed glioblastoma multiforme (GBM). A well tolerated and promising regimen. Proc Am Soc Clin Oncol 1999; 18: 154A (abstr 592).Google Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Heather A. Curry
  • Walter J. CurranJr.

There are no affiliations available

Personalised recommendations