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Journal of Korean Neurosurgical Society 2004;35(2): 127-135.
Clinical Study: Phase II Study of Continuous ACNU (nimustine) and CDDP (cisplatin) Infusion Followed by Conventional Radiotherapy in Patients with High Grade Astrocytomas.
Seung Joon Lee, Sang Hyung Lee, Hee Won Jung, Chae Yong Kim, Dae Seog Heo, Il Han Kim
1Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. nslee@plaza.snu.ac.kr
2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
3Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
4Neuroscience Institute of Medical Research Center, Seoul National University, Seoul, Korea.
This study is aimed at evaluating the efficacy and the toxicity of a 72-hour continuous intravenous infusion of ACNU and CDDP before radiotherapy in adult patients with newly diagnosed anaplastic astrocytoma and glioblastoma. METHODS: Forty-three adult patients with a postoperative Karnofsky performance status greater than 60 were entered into this protocol without any prior treatment. Two cycles of preradiation chemotherapy were performed at 6-week intervals. Conventional radiotherapy was begun 6 weeks later. Magnetic resonance (MR) imaging studies were conducted pre- and postoperatively, and follow-up MR images at the beginning of each treatment and every three months after radiotherapy completion. Response rate, survival rate, prognostic factors and complications were evaluated.
Among 43 patients mentioned above, twenty-one patients completed two cycles of chemotherapy. One patient showed complete remission, ten partial response, seven stable disease and three progressive disease. The median survival time was 15.9 months. Overall response rate was 22.3%. Twenty-seven showed pancytopenia, including two bleeding tendencies, one intracerebral hemorrhage resulting to death, and another two infections. Considering the prognostic factors, only a mutated p53 level of under 20%(% of tumor cells containing mutated p53) was correlated with survival prolongation. Prognostic factor of age under 45 was the only significant factor of extending the time to progression. CONCLUSION: This treatment protocol shows favorable results of preradiation chemotherapy using ACNU and CDDP.
Key Words: ACNU; Anaplastic astrocytoma; CDDP; Chemotherapy; Glioblastoma; Radiotherapy
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