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Accelerated Radiotherapy with Concomitant ACNU/Ara-C for the Treatment of Malignant Glioma

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Abstract

Purpose To evaluate activity and toxicity of simultaneous ACNU and Ara-C with concurrent accelerated hyperfractionated radiotherapy in the treatment of high-grade glioma.

Patients and Methods Thirty patients aged 23–71 years (median 47.5), 16 patients with glioblastoma multiforme (GBM) and 14 patients with grade-III glioma, received 93 courses of ACNU/Ara-C (median 4 courses) at following dose levels (ACNU/Ara-C in mg/m2/day): 70/90 (11 courses), 75/100 (36 courses) and 90/120 (46 courses). ACNU was administered IV on day 1 of each cycle, Ara-C as a 2 h-intravenous infusion on days 1–3. Patients received concomitant radiation therapy with 2 daily fractions of 1.75 Gy up to 57 Gy (median).

Results Median survival of all patients was 13 months, 11 months for GBM and > 28 months for grade-III glioma; 31% (9 patients) survived longer than 24 months. The percentage of grade IV hematological toxicity was dose-dependent: 33% at the 70/90 dose level, 40% at 75/100 and 58% at 90/120. Six patients required platelet transfusion, 1 patient red blood cells; no febrile neutropenia occurred. Among 18 patients evaluable for response, 3 (17%) showed PR, 8 (44%) NC and 7 (39%) PD at completion of chemoradiation. No acute or late neurological toxicity occurred in this study. Younger age (p = 0.0001) and grade-III histology (p = 0.0009) were important prognostic factors for prolonged survival.

Conclusion This chemoradiation regimen is active in malignant gliomas and can be safely recommended at a dose level using 70 mg/m2 ACNU together with 90 mg/m2 Ara-C.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospitals of Erlangen-Nürnberg, Erlangen, Germany

    Katharina Anders, Gerhard G. Grabenbauer, Ulrike Schuchardt, Rainer Fietkau & Rolf Sauer

  2. Department of Neurosurgery, University Hospitals of Erlangen-Nüurnberg, Erlangen, Germany

    Rudolf Fahlbusch

  3. Department of Neurology, Nervenklinik Bamberg, Germany

    Peter Krauseneck

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  1. Katharina Anders
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Anders, K., Grabenbauer, G.G., Schuchardt, U. et al. Accelerated Radiotherapy with Concomitant ACNU/Ara-C for the Treatment of Malignant Glioma. J Neurooncol 48, 63–73 (2000). https://doi.org/10.1023/A:1006498525605

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