Summary
For the non-operable malignant glioma patients, prognosis remains poor, with a survival of 8 months for the glioblastomas (G), and 15 months for anaplastic astrocytomas (AA). 27 histologic proven malignant gliomas (17 AA and 10 G) were treated between April 1991 and June 1992. Median age was 48 years. The therapeutic protocol consisted of three courses of intra arterial chemotherapy (IAC) with ACNU, at intervals of six weeks, and a localised 60 Gy radiotherapy between the first and the second IAC course. 72 courses of IAC were delivered (2,4 per patient). Response rate was 51,8%. Median survival (MS) was 13 months, with a survival rate of 28% at 24 months. For the AA, MS was 21 months, with a survival rate of 37% at 24 months. For the G, median survival was 10 months. Responders were 65 % for AA, 30% for G. Non responders all died before 24 months had relapsed with a MS of 9 months. 54% of responding patients had a 2 years survival. Toxicity were acceptable with 7% of haematological toxicity and a partial loss of visual acuity in 11% of the cases. No chronic neurological sequellae were noted. We compare theses results with two previous trials, concerning inoperable patients, treated by an association of radiotherapy and systemic chemotherapy. Survival seems to be equivalent with HeCNU and with this treatment, but toxicity decreases with ACNU. Early radiotherapy does not increase complications. This treatment can be used for patients with inoperable malignant gliomas.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fine H, Dear K, Loeffler J, Black P, Canellos G: Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer 71: 2585–2597, 1993
Kreith FW, Warnke PC, Scheremet R, Ostertag CB: Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78: 762–766, 1993
Armentrout SA, Foltz E, Vermund H, Otis P: Comparison of post operative irradiation alone and in combination with BCNU in the management of malignant glioma. Cancer Chemother Rep 58: 841–844, 1974
Walker M, Alexander EJ, Hunt W, MacCarty C, Mahaley M, Mealey J, Norrel H, Owens G, Ransohoff J, Wilson C, Gehan E, Stike T: Evaluation of BCNU and/or radiotherapy in the treatment of anaplasic astrocytoma. A cooperative clinical trial. J Neurosurg 49: 333–343, 1978
Stenning ANP, Freedman LS, Bleehen NM: An overreview of published results for randomized studies of nitrosourees in primary high grade malignant glioma. Br J Cancer 56: 89–90, 1987
Deutsch M, Green SB, Strike TA, Burger P, Roberson J, Selker R, Shapiro WJM Jr, rII JR, Paoletti P, Smith K, Odom G, Hunt W Young BEA Jr, Walker M, Pistenmaa D: Results of a randomized trial comparing BCNU plus radiotherapy, streptozotocin plus radiotherapy, BCNU plus hyperfractioned radiotherapy, and BCNU following mizonidazole plus radiotherapy in the postoperative treatment of malignant glioma. Int J Radiation Oncol Biol Physics 16: 1389–1396, 1989
Stewart DJ, Grahovac Z, Hugenholtz H, Russel N, Richard M, Benoit B: Combined intraartrial and systemic chemotherapy for intracerebral tumors. Neurosurgery 21: 207–214, 1987
Rodriguez LA, Prados M, Silver P, Levin VA: Reevaluation of procarbazine for treatment of recurrent malignant central nervous system tumours. Cancer 64: 2420–2423, 1989
Levin VA, Wara WM, Davis RL et al.: Northern California Oncology Group Protocol 6G91: Response to treatment with radiation therapy and seven-drug chemotherapy in patients with glioblastoma multiforme. Cancer Treat Rep 70: 739–743, 1986
Hochberg FH, Pruitt AA, Beck DO, Debrun G, Davis K: The rational and methodology for intra-cranial chemotherapy with BCNU as treatment for glioblastoma. J Neurosurg 63: 876–880, 1985
Chiras J, Debussche C, Chedid G: Intra-arterial chemotherapy for brain tumors. In: van Halbrach V, Dion J, Vinuela F (ed) Textbook of Interventional Neuroradiology: Endovascular Therapy of the Central Nervous System, Raven Press, pp Page,1992
Ameri A, Poisson M, Chauveinc L, Chen QM, Delattre JY: Treatment of recurrent malignant supratentorial gliomas with association of carboplatin and etoposide: A phase II study. Neurology 43: 367, 1993
Vega F, Davila L, Chatellier G, Chiras J, Fauchon F, Capelle L, Poisson M, Delattre JY: Treatment of malignant gliomas with surgery, intraarterial chemotherapy with ACNU and radiation therapy. J Neuro-Oncol 13: 131–135, 1992
Papavero L, Loew F, Jaksche H: Intracarotid infusion of ACNU and BCNU as adjuvant therapy of malignant gliomas. Clinical aspects and critical considerations. Acta Neurochirurgica 85: 128–135, 1987
Chiras J, Fauchon F, Poisson M, Debussche C, Chauveinc L, Pereon Y, Guerin RA, Bories J: Traitement des gliomas malins inopérables. Chimiotherapie intra-artérielle non hyperselective par HECNU suivie de radiotherapie conventionelle. Revue de Neurologie (Paris) 145: 829–837, 1989
Roosen N, Kiwit JCW, Lins E, Schirmer M, Bock WJ: Adjuvant intraarterial chemotherapy with nimustine in the management of World Health Organization grade IV of the brain. Cancer 64: 1984–1994, 1989
Takakura K, Abe H, Tanaka R, Kitamura K, Miwa T, Takeuchi K, Yamamoto S, Kageyama N, Handa H, Mogami H, Nishimoto A, Uozomi T, Matsutani M, Nomura K: Effects of ACNU and radiotherapy on malignant glioma. J Neurosurg 64: 53–57, 1986
Wasserman HT, Slavic M, Carter SK: Clinical comparison of the nitrosoureas. Cancer 36: 1258–1268, 1975
Yamashita J, Hande H, Tokuriki T, Ha YS, Otsuka SI, Suda K, Taki W: Intra-arterial ACNU therapy for malignant brain tumors. Experimental studies and preliminary results. J Neurosurg 59: 424–430, 1993
Constans J, Schlienger M: Indication de la radiotherapie dans les tumours intracraniennes ou intrarachidiennes de l'adulte. Neurochirurgie (Paris) 21: 1–255, 1975
Pouillart P, Mathe G, Ty T, Lheritier J, Poisson M, Huguenin P, Morin P, Parrot R: Treatment of malignant gliomas and brain metastases with a combination of Adriamycine, VM, and CCNU26. Cancer 38: 1909–1916, 1976
Nelson D, Davis J, Chang C, Griffin T, Pajak T: Survival and prognosis of patients with astrocytoma with atypical or anaplastic features. J Neuro-Oncol 3: 99–103, 1985
Glantz M, Burger P, Herndon J, Friedman A, Craincross J, Vick N, Schold S: Influence of type of surgery on the histologic diagnosis in patients with anaplastics gliomas. Neurology 41: 1741–1744, 1991
Rosenblum MK, Delattre JY, Walker RW, Shapiro WR: Fatal necrotizing encephalopathie complicating treatment of malignant gliomas with intra-arterial BCNU and irradiation: a pathological study. J Neuro-Oncol 7: 269–281, 1989
Martinez-Pietro JN, Yung WKA, Feun LG, Lee YY: Toxicity of intra-carotid chemotherapy for patients with malignant brain tumours. Cancer Bull 38: 49–53, 1986
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Chauveinc, L., Sola-Martinez, M.T., Martin-Duverneuil, M. et al. Intra arterial chemotherapy with ACNU and radiotherapy in inoperable malignant gliomas. J Neuro-Oncol 27, 141–147 (1996). https://doi.org/10.1007/BF00177477
Issue Date:
DOI: https://doi.org/10.1007/BF00177477