YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==ASTROCYTOMA, ANAPLASTIC== 1 AUTHOR Urtasun RC AUTHOR Kinsella TJ AUTHOR Farnan N AUTHOR DelRowe JD AUTHOR Lester SG AUTHOR Fulton DS TITLE Survival improvement in anaplastic astrocytoma, combining external radiation with halogenated pyrimidines: final report of RTOG 86-12, Phase I-II study [see comments] SOURCE Int J Radiat Oncol Biol Phys; VOL 36, ISS 5, 1996, P1163-7 ABSTRACT PURPOSE: This study evaluated the toxicity and tumor efficacy of the halopyrimidine IUdR as a chemical modifier of radiation response in patients with malignant glioma. The preliminary results published in 1993 demonstrated no real advantage in the group of patients with glioblastoma. However, a benefit appeared to be evolving in the group of patients with Anaplastic Astrocytoma (AA). We are now presenting the results on the long-term follow-up of patients with AA. METHODS AND MATERIALS: Between August 1987 and October 1991, 79 patients were entered in a prospective study with newly diagnosed malignant glioma. Twenty-one of 79 were AA. The study was designed to have a fixed dose of radiation consisting of 60.16 Gy in 32 fractions in 6.5 weeks but varying the dose schedule of IUdR, delivered in a continuous intravenous infusion of long (96 h) or short (48 and 24 h) duration, every week for the 6.5 weeks of radiation treatment. RESULTS: The last AA patient was entered in March 1991. Ninety-five percent of the AA patients were under 59 years of age and 86% had a Karnofsky score 80. Thirty-eight percent had a tumor diameter of less than 5 cm and 52% had a tumor diameter between 5-10 cm. Seventy-six percent had partial or total tumor resection. The toxicity of this treatment was acceptable and has already been published elsewhere. At the time of this report, 14 out of 21 patients with AA are dead. The median survival, calculated from the Kaplan-Meier, is 3.2 years. Thirty-three percent of the patients have survived 5 years. These results compare favorably with the best results reported in the literature with postoperative external radiation plus chemotherapy, median survival time (MST) of 3 years, and previous Radiation Therapy Oncology Group (RTOG) experience with radiation alone, MST of 2 years. CONCLUSIONS: Our findings in patients with AA corroborate the improved therapeutic results published recently when combining external radiation with "long" infusion of i.v. BUdR and indicate the need to proceed with randomized Phase III studies utilizing halogenated pyrimidines and radiation. One such study has already been activated, RTOG # 94-04. 2 AUTHOR Silvani A AUTHOR Salmaggi A AUTHOR Pozzi A AUTHOR Fariselli L AUTHOR Franzini A AUTHOR Boiardi A TITLE Effectiveness of early chemotherapy treatment in anaplastic astrocytoma patients. SOURCE Tumori; VOL 81, ISS 6, 1995, P424-8 ABSTRACT There are limited data in the literature concerning chemotherapy trials for the treatment of anaplastic astrocytomas. Forty-one anaplastic astrocytoma patients, operated on during the period 1988 to 1993 at the Neurological institute of Milan, received 4-5 cycles of chemotherapy (BCNU + cisplatin), subsequently radiotherapy (median dose 56.5 Gy), and finally a second-line chemotherapy protocol at recurrence (procarbazine, vincristine, lomustine). The aim of the study was to evaluate the effectiveness of the planned protocol, considering the time to tumor progression and the survival time. The group of anaplastic astrocytoma patients was compared with a homogeneous group of 39 anaplastic astrocytoma patients treated only with radiotherapy after surgery. The median time to tumor progression of patients on the protocol was 24.5 months. The median survival time for anaplastic astrocytoma patients treated with our scheduled protocol or only with radiotherapy was 38.8 and 21 months, respectively. However, our data need to be confirmed by large randomized clinical studies. 3 AUTHOR Krishnasamy S AUTHOR Vokes EE AUTHOR Dohrmann GJ AUTHOR Mick R AUTHOR Garcia JC AUTHOR Kolker JD AUTHOR Wollmann RL AUTHOR Hekmatpanah J AUTHOR Weichselbaum RR TITLE Concomitant chemoradiotherapy, neutron boost, and adjuvant chemotherapy for anaplastic astrocytoma and glioblastoma multiforme [see comments] SOURCE Cancer Invest; VOL 13, ISS 5, 1995, P453-9 ABSTRACT The survival rate for patients with malignant gliomas is poor. We describe the results of a prospective study using concomitant chemoradiotherapy, neutron boost, and adjuvant chemotherapy for patients with malignant gliomas. Forty-two patients with anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM) were treated with postoperative photon radiation 45 Gy/25 fraction (fxs) with concomitant continuous intravenous infusion of 5-fluorouracil at 300 mg/m2/day x 5 days and hydroxyurea 0.5 g orally every 12 hr for 6 days for 5 consecutive weeks, followed by a neutron boost of 450 N cGy/6 fxs delivered twice weekly. Adjuvant chemotherapy with procarbazine, CCNU, and vincristine (PCV) was given up to 1 year or until tumor progression. Thirty-four patients (81%) had GBM and 8 patients (19%) had AA. Sixteen patients (38%) were ineligible for the neutron boost because of large tumors or poor performance status and instead received a photon boost with concomitant chemotherapy for a total dose of 60-65 Gy to the tumor. The overall median survival is 68 weeks at a median follow-up of 203 weeks (range 166-302 weeks for the 11 patients remaining alive); 7/8 patients with AA are alive, 2 of these with progressive disease. For AA the median survival is not reached at a median follow-up of 203 weeks (range 166-302 weeks for the 7 patients alive with AA). Time to tumor progression for the 1 dead patient with AA was 35 weeks and the other 2 patients failed at 171 weeks and 179 weeks following treatment. The median survival for the 34 patients with GBM was 62 weeks; 4/34 patients with GBM are alive at 285, 238, 216, and 206 weeks. Multivariate survival analysis in the 34 patients with GBM revealed age and Karnofsky performance status as important prognostic factors. Extent of surgery and neutrons did not affect survival. Concomitant chemoradiotherapy was well tolerated by all patients. The only toxicities observed were mucositis < or = grade II in 3 patients (7%) and mild myelosuppression in 1 patient (2.4%). Adjuvant PCV was well tolerated. Continuous concomitant chemoradiotherapy was well tolerated by all patients with acceptable side effects. The survival rate for the patients with GBM suggests no significant impact on the prognosis for these patients. Patients with AA did well; however, the patient numbers are small. 13 AUTHOR Afra D AUTHOR Kerpel-Fronius S AUTHOR Szinai I AUTHOR Kocsis B AUTHOR Eckhardt S TITLE Combined treatment of anaplastic astrocytoma (grade 3-4) with diacetyl-dianhydro-galactitol (DADAG). SOURCE J Neurooncol; VOL 8, ISS 1, 1990, P85-91 ABSTRACT Autoradiographic studies of labeled diacetyldianhydro-galactitol (DADAG) with tumor bearing animals revealed that the CNS accumulates high amounts of DADAG-derived radioactivity and the elimination from the brain seems to be relatively slow. This observation and the activity of DADAG against murine ependymoblastoma classified the drug as a promising agent for the treatment of malignant brain tumors. In a series of 30 evaluable consecutive patients who were operated on for anaplastic astrocytomas, DADAG has been applied during and subsequent to postoperative radiotherapy. No severe toxicity occurred. Survivals were compared with a group of patients who got irradiation alone. Statistical analysis did not show significantly better survivals in the DADAG treated group: median value was 46.5 weeks, p = 0.232. 15 AUTHOR Nelson DF AUTHOR Nelson JS AUTHOR Davis DR AUTHOR Chang CH AUTHOR Griffin TW AUTHOR Pajak TF TITLE Survival and prognosis of patients with astrocytoma with atypical or anaplastic features. SOURCE J Neurooncol; VOL 3, ISS 2, 1985, P99-103 ABSTRACT This study confirms the importance of histologic tumor necrosis as a major prognostic variable in malignant glioma. Necrosis is present in glioblastoma multiforme (GBM), and absent in astrocytoma with atypical or anaplastic features (AAF). This paper evaluates 94 patients with AAF and 462 patients with GBM treated with radiation therapy with or without BCNU on 3 consecutive randomized protocols of the Radiation Therapy Oncology Group (RTOG) between 1974 and 1983. Multivariate analyses of the 556 patients confirmed histology as a significant independent variable that is prognostically relatively more important than Karnofsky performance status (KPS) and extent of surgery, and somewhat less important than age. The median survival for AAF was 36.2 months and for GBM was 8.6 months. In addition, separate multivariate analyses of AAf cases determined that the extent of surgery is a significant independent variable that is relatively more important than KPS, but less important than age. The median survival of AAF patients who underwent surgical excision was 46.8 months compared with 15.2 months for those biopsied (p less than .001).