Abstract
We wondered whether second line chemotherapy in recurrent GBM patients might be useful for debulking the tumor mass and improving patient performance status to prepare the way for second surgical intervention. We have treated 18 recurrent glioma patients with high dose methotrexate (HDMTX) plus 5-fluorouracil (5FU). 5 Patients were responders, 6 had stable disease, and 7 disease progression. 6 patients, 3 PRs and 2 SDs, underwent a second operation after two chemotherapy cycles. Disease progression resumed at 11.5±7 weeks in the non reoperated patients, and at 32.6±9.3 weeks in the reoperated group from initiation of neoadjuvant treatment. Survival time in reoperated patients was 82.6 weeks. Although our experience with this policy is still limited, we believe that reoperation in selected recurrent GBM patients can be worthwhile.
Sommario
In questo lavoro sono stati trattati secondo l'associazione Methotrexate ad alte dosi (HDMTX) e 5 Fluoro-uracile 18 pazienti affetti da glioblastoma recidivo. Lo scopo dello studio è stato verificare se in pazienti affetti da glioblastoma un trattamento chemioterapico di seconda linea potesse creare le condizioni per il reintervento. Alla conclusione del secondo ciclo polichemioterapico abbiamo osservato 5 risposte complete, 6 stabilità di malattia e 7 progressioni. Il miglioramento clinico successivo al trattamento chemioterapico ha permesso il reintervento in 5 pazienti. A partire dalla data di esecuzione del primo ciclo chemioterapico la ripresa di malattia è stata osservata rispettivamente alla 11.5 e 32.6 settimana nei pazienti non operati e nei rioperati. La sopravvivenza media globale nei pazienti rioperati è stata di 82.6 settimane dalla diagnosi.
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References
Alley M.C., Scudiero D.A., Monks A.:Feasibility of drug screening with panels of human tumor cell lines using a microculture tetrazolium assay. Cancer Res. 48:589–601, 1988.
Ammirati M., Galicich J., Arbit E., Liao Y.: Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurg. 5:607–613, 1987.
Dakhil S., Ensminger W., Strother V.:Pharmacokinetics of intraventricular 5-fluoro-2-deoxiuridine (FUDR) in patients with meningeal neoplasia. Proc. Am. Assoc. Caner. Res. 22:178–183. 1981
Dierassi I., Jung Sun Kim, Reggev A.:Response of astrocytoma to high-dose methotrexate with citrovorum factor rescue. Cancer 55:2741–2747 1985.
Djerassi I., Kim J.S., Shulman K.:High-dose methotrexate citrovorum factor rescue in the management of brain gliomas. Cancer Treat. rep. 61:691–694, 1977.
Dierassi J.S., Kassarov L., Regev A., Gandhi V., Srivastava B.:High dose methotrexate with citrovorum factor in astrocytoma. Proceedings of ASCO 7:83, 1988.
Evans, W.E., Huston P.R., Steward C.R.:Methotrexate cerebrospinal fluid and serum concentration after intermediate dose methotrexate infusion. Cancer Pharmacol. Ther. 33:301–307, 1983.
Evans W.E., Pratt C.B., Taylor R.H., Barker L.F., Crow W.R.:Pharmacokinetic monitoring of high-dose MTX: early recognition of high-risk patients. Cancer Chemother. Pharmacol. 3:161–166. 1979
Fernandes D., Bertino J.:5-fluorouracil-methotrexate synergy: enhancement of 5-fluorodeoxyuridylate binding to thymidylate synthase by dihydropteroylpolyglutamates. Proc. Natl. Acad. Sci USA. 10:5663–5667, 1980.
Freeman A.I., Wang J.J., Sinks L.F.:High dose MTX in acute lymphocytic leukemia.Cancer Treat Rep. 60:727–731, 1977.
Griffith R., Levin V.A., Gutin P.H., Seager M., Silver P., Wilson C.M.:Reoperation for recurrent glioblastoma and anaplastic astrocytomas. Neurosurgery 21:615–621, 1987.
Kornblith P.L., Walker M.:Chemotherapy for malignant gliomas. J. Neurosurg. 68:1–7, 1988.
Leone A.B., Romero A., Rabinovich M., Perez J.E., Macchiavelli M. andStrauss E.:Sequential Therapy with methotrexate and 5-fluorouracil in the treatment of advanced colorectal carcinoma. J. Clin. Oncol.: 4,1 23–27, 1986.
MacDonald D.R., Cascino T.L., Shola C.S. Jr., Caincross J.G.:Response criteria for phase II studies of supratentorial malignant glioma. J. Clin. Oncol.: 8(7), 1277–1280, 1990.
Oken M.M., Creech R.H., Tormey D.C., Horton J., Davis T., McFadden E.T., Carbone P.P.:Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. 5:649–655, 1982.
Pool J.L.:The management of recurrent gliomas. Clin. Neurosurg. 15:265–287, 1969.
Ray, B.S.:Surgery of recurrent intracranial tumor. Clin. Neurosur. 10:1–30, 1964.
Rosen G., Ghavimi F., Vannucci R., Reck M., Tan C., Murphy M.L.:Pontine glioma: high-dose methotrexate and leucovorin rescue. JAMA 230:1149–1152, 1974.
Roth J.G., Elvige A.R.:Glioblastoma multiforme. A clinical survey. J. Neurosurg. 17:736–750, 1960.
Salcman M.:Survival in glioblastoma: Historical perspective. Neurosurg. 7:435–439, 1980.
Salcman M.:Effects of age and reoperation on survival in combined multimodality treatment of malignant astrocytomas. Neurosurg. 10:454–463, 1982.
Shapiro W.R.:High-dose methotrexate in malignant gliomas. Cancer Treat. Rep. 61:753–756, 1977.
Shapiro W.R., Young D.F., Metha B.M.:Methotrexate distribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. N. Engl. J. Med. 293:161–166, 1975.
Steward D.J.:The role of chemotherapy in the treatment of gliomas in adults. Cancer Treat. Rev. 16(3):129–160, 1989.
Young B., Oldfield E.H., Markesbery W.R., Haack D., Tibbs P.A., McCombs P., Chin H.W., Maruyama Y., Mancham W.F.:Reoperation for glioblastroma. J. Neurosurg. 55:917–921, 1981.
Yukitaka Ushio, Toru Hayakawa, Heitaro Mogami:Uptake of tritiated methotrexate by mouse brain tumors after intravenous or intrathecal administration. J. Neurosurg. 40:706–716, 1974.
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Boiardi, A., Silvani, A., Croci, D. et al. Neoadjuvant chemotherapy in the treatment of recurrent glioblastomas (GBM). Ital J Neuro Sci 13, 583–588 (1992). https://doi.org/10.1007/BF02233401
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DOI: https://doi.org/10.1007/BF02233401