Radiotherapy followed by adjuvant temozolomide treatment of malignant glioma
Tzu-Ming YangHung‐Chen WangYu-Jun LinWei-Che LinCheng‐Hsien LuWen‐Neng ChangHsueh‐Wen ChangJih-Tsun Ho
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Keywords:
Temozolomide
Dacarbazine
Adjuvant Therapy
Anaplastic astrocytomas and glioblastomas are the most frequent and most malignant hemispherial tumours. Unfortunately, astrocytic tumours are of infiltrative character and radical removal is not possible. Recurrent malignant gliomas are rarely suitable for reoperation. In most of the cases of recurrent gliomas chemotherapy is the last choice.Seventy-five consecutive patients with recurrent malignant astrocytomas and glioblastomas had been treated at our institute with per os temozolomide for five days every month. The patients received two to 16 courses of chemotherapy. The toxicity, quality of life, response to chemotherapy and survival data were analysed.Out of 75 patients four were excluded following the first treatment due to myelotoxicity, and allergic reactions. Among the patients treated with temozolomide in seven cases complete response, 17 partial response, 14 progressive disease were observed. In 33 cases the disease stabilized and out of them in 27% a significant neurological improvement was detected. The time to progression was 6.8 months and the median survival time 8.75 months for patients with glioblastoma and with malignant astrocytoma or malignant mixed oligoastrocytoma 9.45 and 11.15 months, respectively. The overall survival for patients with originally lower grade glioma was 70.32 and for patients with glioblastoma multiforme 17.43 months.Temozolomide chemotherapy in patients with recurrent malignant astrocytoma and glioblastoma proved to be efficacious and similar good results were achieved as with a nitrosourea based combined chemotherapy. Even in those patients who received previous chemotherapy temozolomide is well tolerated and a relatively long time to progression was achieved in cases of recurrent malignant gliomas. In a few number of patients where BCNU had been previously failed with temozolomide stable disease was achieved. Temozolomide seems to be a promising drug in the chemotherapy of malignant gliomas and can be applied as a second line chemotherapy, as well.
Temozolomide
Anaplastic astrocytoma
Nitrosourea
Dacarbazine
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Objective To evaluate the results of postoperative concurrent Temozolomide(TMZ)chemotherapy with radiotherapy for high grade glioma(HGG).Methods Thirty-seven patients with HGG were treated from Apr.2004 to Oct.2007.Twenty-two patients(11 of grage Ⅲ and 11 grade Ⅳ) were treated by concurrent TMZ chemoradiotherapy with radiotherapy(A group),and fiveteen patients(7 of grage Ⅲ and 8 of grade Ⅳ) were treated by radiotherapy along(B group).A group received concurrent TMZ chemoradiotherapy(75 mg/m2·d) for 6 weeks.Sequential TMZ chemotherapy(150-200 mg/m2·d) after the radiotherapy was carried out for 2-4 weeks.Sereotactic conformal radiotherapy was deli-vered by 6 MV/10 MV-X,and patients received overall DT 60-75 Gy.Hyperfractionated radiotherapy of 1.8-3 Gy/day were delivered,5 day/week.Results One and two years survival rates in A and B groups were 64.8% and 53.3%;40% and 26.7%,respectively.There was a significance difference between the concurrent TMZ chemotherapy with radiotherapy group and radiotherapy along group(P=0.002).This results showed that concurrent TMZ chemotherapy with radiotherapy increased survival times.Conclusions Concurrent TMZ chemotherapy with radiotherapy is much better than the radiotherapy along for HGG.It is worthy of clinical application.
Temozolomide
Chemoradiotherapy
Dacarbazine
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overall survival (OS) and progression-free survival (PFS), but improvements in long-term survival remain challenging.Standard therapy for malignant glioma consists of the maximal tumor resection with concomitant chemoradiotherapy.Among chemotherapy agents, temozolomide (TMZ) is the standard agent used in the treatment of malignant glioma (27).TMZ is an oral alkylating agent that has been shown to improve the survival of patients with malignant glioma.However, even with surgery and TMZ therapy, prognosis remains poor and tumor relapse rates remain high.The relatively modest effects █ InTRODuCTIOn M alignant gliomas are the most common and lethal primary tumors of central nervous system (20), producing serious and progressive disability prior to patient death.Despite the advances in chemoradiotherapy, the survival rate for malignant glioma has remained very low.The majority of glioblastoma patients survive for about two years (17), and only a few patients would survive longer than 5 years (26); WHO III glioma patients would survive ranging from 3 to 5 years ( 22).Surgery and chemoradiotherapy can improve AIM: Malignant glioma is the most common primary brain tumor in adults and the survival rate has remained very low.Thus, determining the optimal treatment for patients can be challenging.To compare the efficacy of common therapies, we performed network meta-analysis to estimate the efficacy and safety among procarbazine, lomustine, vincristine, temozolomide, bevacizumab plus temozolomide, and placebo for patients with malignant glioma. MATERIAL and METhODS:Relevant studies (as of March, 2014) were identified by searching PubMed, Embase, and Central databases.The primary endpoint of the analysis was the overall survival (OS) and progression-free survival (PFS) of glioma patients. RESuLTS:Nine trials with a total of 3472 patients were included in our network meta-analyses.Compared with placebo, bevacizumab plus temozolomide was associated with the highest estimates of OS and PFS for 12 and 24 months (12 month OS odds ratio [OR]: 2.44; 95% credibility interval [CrIs]: 0.76-9.69;24 month OS OR: 2.56; 95% CrIs: 1.12-5.24;12 month PFS OR: 6.76; 95% CrIs: 2.80-17.34;24 month PFS OR: 3.69; 95% CrIs: 0.62-28.63).However, bevacizumab plus temozolomide did not significantly improve OS or PFS compared to temozolomide alone.COnCLuSIOn: Bevacizumab plus temozolomide combination therapy is not significantly more effective than temozolomide alone in improving survival of glioma patients.Moreover, bevacizumab was associated with higher hematologic toxicities.Bevacizumab should be used with caution in glioma patients.Additional randomized controlled trials are required to confirm this finding.
Temozolomide
Lomustine
Procarbazine
Dacarbazine
Progression-free survival
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Objective To compare the curative effects and safety of temozolomide plus radiotherapy in the treatment of post-operative malignant glioma.Methods 55 postoperative patients with pathologically confirmed malignant glioma were randomly assigned to receive temozolomide plus radiotherapy(experiment group,n= 21),125I or 131I intra-radiotherapy alone(control group ;n=15) and temozolomide alone(control group;n=19).All patients were followed up in long term for observation the time to progression,over all survival time and safety.Results Median time to progression was(56.33±3.36) weeks in experiment group,(44.83±4.55) and(41.5±3.95) weeks in control group(P 0.05).Median overall survival time was(59.27 ±3.19) weeks in experiment group,compare to(50.19±4.80) and(47.65±3.97) weeks in control group(P 0.05).Only one patient experienced leukopenia and released with dose reduction treatment.Conclusions Temozolomide plus radiotherapy is more effective than intra-radiotherapy or chemotherapy alone in the treatment of malignant glioma and is well tolerated.
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Leukopenia
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Radiochemotherapy adjuvant to surgery are common treatment for glioma. Chemotherapy plays an important role in the treatment process. Temozolomide(TMZ) is a new oral antineoplastic agent,which occupies more and more important standing in glioma chemotherapy. The article summarizes application of TMZ for glioma at home and abroad.
Temozolomide
Dacarbazine
Adjuvant Chemotherapy
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Temozolomide
Dacarbazine
Adjuvant Therapy
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Temozolomide
Regimen
Chemotherapy regimen
Lomustine
Brain tumor
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Dacarbazine
Adjuvant Therapy
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Temozolomide
Lomustine
Oligodendroglial Tumor
Dacarbazine
Nitrosourea
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Temozolomide
Concomitant
Anaplastic astrocytoma
Adjuvant Therapy
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