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chemotherapy for children with highly malignant brain tumors
S175 686
687
LONG TERM SURVIVORS IN METASTATIC SPINAL CORD COMPRESSION (MSCC). ANALYSIS OF 299 CONSECUTIVE PATIENTS UNDERGOING RADIOTHERAPY (RT) W I T H O U T SURGERY.
SYNCHRONOUS RADIO/CHEMOTHERAPY FOR CHILDREN WITH HIGHLY MALIGNANT BRAIN TUMORS
Maranzano E., Marafioti L, Barone V., Piro F., Perrucci E., Panizza B.M., Lupattelli M., Aristei C., Marseila A.R., Latini P.
B Pakisch ~, C.Urban 2, H.Lackner2, H Leitner I, G.Sttlcklschweiger R, F.Schmidt ~, A.Hacklk Dep of Radiotherapy t Univ Clinic of Radiology 3, Univ Children Hospital", Graz, Austria
U.O. Radioterapla Oncologica, Ospedale Poficlinico - Perugla, Italy. Survival of MSCC patients is generally poor, but selected cases may survive 4 to 9 years. Survival of 299 consecutive MSCC patients undergoing RT without surgery from October '86 to March '94, was analysed. Three different RT regimens were given: 3-30 Gy in l0 fractions, a split course regimen (5 Gy x 3 and then 3 Gy x 5), or a short-course RT of8 Gy repeated after I week. Chemotherapy and/or hormonal therapy were given in potentially ehemo-hormonal sensitive cases. Median survival of whole group was 5.5 months (range l-I 1 l) with 8% of 5-year-survival probability. Median survival was conditioned by patients pretreatmont status (8 months walking cases vs. 4 months others, p = 0.003), post-treatment capacity (9 months, walking eases vs. I month otbers, p < 0.0001) and primary tumor type (10 months in favorable histologies -breast and prostate carcinomas, myeloma and lymphoma- vs 2 months others, p < 0.0001). Long term survivors (patients with survival _> 2 years) were 30 of 299 (10%) treated cases, survival ranging from 26 to 111 months. All long term survivors were ambulant after RT and generally had a radiosensitive primary tumor type. Considering long term survival according to histology, 20 of 98 (20%) patients had breast cancer, 3 of 18 (17%) myeloma, 3 of 32 (9%) prostate cancer, 2 of 9 (22%) lymphoma, I of 10 (10%) unknown primary tumor and 1 of 49 (2%) lung carcinoma. Five-year- survival probability was 25% for lymphoma and 13% for breast cancer patients, and survival range was 83-111 months and 3183 months, respectively. Women with MSCC and bone metastases from breast cancer had a median survival of 16 months vs. 6 months for those with MSCC and metastases both in bone and other sites (p = 0.02). No late toxicity was found. Although the effect on survival of RT is not clear, it appears that effective local treatment is associated with improved survival.
Background: Despite improvements in neurosurgical techniques, the increasing use of multidrag conbinations followed by high dose irradiation, the results in the treatment of highly malignant and incompletely operated brain tumors remain extremely poor. Purpose: In an attempt to improve local control, a multimodal approach was developed, which consisted of early postoperative multidrug chemotherapy in combination vdth the administration of synchronous (hyper)fractionated-radiotherapy. Methods and Material: 14 patients with extremely dismal prognoses were treated with the German-HIT 91 protocol and in addition received cranial (60-70 Gy, bid) or craniospinal (50-55 Gy,spinal dose 35 Gy) irradiation synchronous to the induction chemotherapy. Resuhs: Eleven patients were alive between 6 and 24 (median 12,5) months post treatment. Objective tumor regression was observed in 7/14 patients, with a complete response in 6 cases. The main acute toxicities were all related to polychemotherapy. Complications related to the combined modality treatment were skin and ototoxicity, respectively. Acute toxicity was severe, however no acute or delayed encephalopathy was observed. ('onclu.~ton: Tumor regression in 50% of the patients and no neurologic deterioriation suggest that synchronous chemoradiotherapy has a considerable therapeutic effect in high malignant childhood brain tumors. Nevertheless it remains to be seen if long term toxici .ty may be severe in patients who survived their malignant condition which otherwise would have led to tumor death
688
689
LARGE DOSEFRACTIONRADIOTHERAPYWITHCHEMOTHERAPYIN TREATMENTOF MALIGNANTBRAINTUMOUR IN ADULTS
RESULTS OF RADIATION THERAPY IN PATIENTS Wrl2-1 BRAINSTEM GLIOMAS
M. Pamucka, UCzopkiewicz-RadiationTher~yDept.-Opole, POLAND
Sanz MC, Martfn M, Romero J, Regueiro CA, de la Torte A, Valc.~h'cel FJ, Magall6n R, Velasco J, and Arag6n G. Dept. of Radiation Oncology. Clinica Puerta de Hierro. Madrid. Spain
In the the years 1990-1995 in our Department we applied the large dose fraction radiotherapy with chemotherapy for GBM and AA in adults. The patients up to 60 years old with anaplastic astrocytoma and glioblastoma multiforme after paliative surgery procedure were qualified for this treatment. The chemotherapy: CCNU (120140mg/m2) was started 2-4 weeks after operation. The radiotherapy was started 10-12 days later. The patients were irradiated with the coblat unit, 6 Gy/day to the tumour bed only, twice weekly, to the total dose 42-54 Gy. After the end of the radiotherapy, the chemotherapy in the same dose every 6 weeks, to 5-6 doses at all, was continued. These treatment(RT+ChT) were applied to 24 patients with AA and 17 with GBM. Results: the average survival in the patients with AA is 27,8 months and in the patients with GBM 10,7 months. We did not state the serious side effects. Conclusions: radiotherapy with large dose fractions for the brain tumours in adults is good method. The results of this method are similar to the results of conventional radiotherapy. The mentional method is well tolerated and allows the treatment get short.
Due to the considerable hazards associated to the surgical resection of brainstem gliomas, radiotherapy remains the routinely used treatment. We evaluated the results of this treatment approach and the factors that influence the prognosis of these patients. Patients and methods: We have evaluated 48 patients with brainstem tumors treated at our department between 1965 and 1993. Nineteen patients had histological verification of tumor type 0 6 low grade and 3 high grade astrocytomas) and the diagnosis was based on clinical and radiographic findings in 27 patients. Twenty-one patients were male and 27 were female. Their median age was 9 years (range 1 to 66 years). The mean duration of symptoms was 6 months. The length of the largest diameter of the tumors varied between 2 and 8 cm (mean 4.5). Twenty-two minors (45%) involved the IV ventricle, 16 (33%) the cerebellar peduncles, and 19 (35%) involved the mecl.ulla. CSF diversions were performed in 16 patients (33%) to relieve hydrocephalus. All patients were treated using megavoltage equipment and most patients were treated using two parallel opposed lateral fields. The probabilities of relapse free survival and overall survival were calculated using the Kaplan-Meier method and differences between curves were evaluated using the log-rank test. Results: Of 48 patients, 33 (69 %) died of tumor related causes, 12 are alive without disease and 3 were lost to follow-up. The five and ten year actuarial relapse free survival probabilities were 26% and 23% respectively. The five and ten year overall survival probabilities were 2770 and 2370. The probability of survival was significantly lower in female patients and those less than ten year old. Age significantly influenced the probability of relapse free survival. Conclusions: Brainstem tumors have a poor prognosis specially in young patients.
687
LONG TERM SURVIVORS IN METASTATIC SPINAL CORD COMPRESSION (MSCC). ANALYSIS OF 299 CONSECUTIVE PATIENTS UNDERGOING RADIOTHERAPY (RT) W I T H O U T SURGERY.
SYNCHRONOUS RADIO/CHEMOTHERAPY FOR CHILDREN WITH HIGHLY MALIGNANT BRAIN TUMORS
Maranzano E., Marafioti L, Barone V., Piro F., Perrucci E., Panizza B.M., Lupattelli M., Aristei C., Marseila A.R., Latini P.
B Pakisch ~, C.Urban 2, H.Lackner2, H Leitner I, G.Sttlcklschweiger R, F.Schmidt ~, A.Hacklk Dep of Radiotherapy t Univ Clinic of Radiology 3, Univ Children Hospital", Graz, Austria
U.O. Radioterapla Oncologica, Ospedale Poficlinico - Perugla, Italy. Survival of MSCC patients is generally poor, but selected cases may survive 4 to 9 years. Survival of 299 consecutive MSCC patients undergoing RT without surgery from October '86 to March '94, was analysed. Three different RT regimens were given: 3-30 Gy in l0 fractions, a split course regimen (5 Gy x 3 and then 3 Gy x 5), or a short-course RT of8 Gy repeated after I week. Chemotherapy and/or hormonal therapy were given in potentially ehemo-hormonal sensitive cases. Median survival of whole group was 5.5 months (range l-I 1 l) with 8% of 5-year-survival probability. Median survival was conditioned by patients pretreatmont status (8 months walking cases vs. 4 months others, p = 0.003), post-treatment capacity (9 months, walking eases vs. I month otbers, p < 0.0001) and primary tumor type (10 months in favorable histologies -breast and prostate carcinomas, myeloma and lymphoma- vs 2 months others, p < 0.0001). Long term survivors (patients with survival _> 2 years) were 30 of 299 (10%) treated cases, survival ranging from 26 to 111 months. All long term survivors were ambulant after RT and generally had a radiosensitive primary tumor type. Considering long term survival according to histology, 20 of 98 (20%) patients had breast cancer, 3 of 18 (17%) myeloma, 3 of 32 (9%) prostate cancer, 2 of 9 (22%) lymphoma, I of 10 (10%) unknown primary tumor and 1 of 49 (2%) lung carcinoma. Five-year- survival probability was 25% for lymphoma and 13% for breast cancer patients, and survival range was 83-111 months and 3183 months, respectively. Women with MSCC and bone metastases from breast cancer had a median survival of 16 months vs. 6 months for those with MSCC and metastases both in bone and other sites (p = 0.02). No late toxicity was found. Although the effect on survival of RT is not clear, it appears that effective local treatment is associated with improved survival.
Background: Despite improvements in neurosurgical techniques, the increasing use of multidrag conbinations followed by high dose irradiation, the results in the treatment of highly malignant and incompletely operated brain tumors remain extremely poor. Purpose: In an attempt to improve local control, a multimodal approach was developed, which consisted of early postoperative multidrug chemotherapy in combination vdth the administration of synchronous (hyper)fractionated-radiotherapy. Methods and Material: 14 patients with extremely dismal prognoses were treated with the German-HIT 91 protocol and in addition received cranial (60-70 Gy, bid) or craniospinal (50-55 Gy,spinal dose 35 Gy) irradiation synchronous to the induction chemotherapy. Resuhs: Eleven patients were alive between 6 and 24 (median 12,5) months post treatment. Objective tumor regression was observed in 7/14 patients, with a complete response in 6 cases. The main acute toxicities were all related to polychemotherapy. Complications related to the combined modality treatment were skin and ototoxicity, respectively. Acute toxicity was severe, however no acute or delayed encephalopathy was observed. ('onclu.~ton: Tumor regression in 50% of the patients and no neurologic deterioriation suggest that synchronous chemoradiotherapy has a considerable therapeutic effect in high malignant childhood brain tumors. Nevertheless it remains to be seen if long term toxici .ty may be severe in patients who survived their malignant condition which otherwise would have led to tumor death
688
689
LARGE DOSEFRACTIONRADIOTHERAPYWITHCHEMOTHERAPYIN TREATMENTOF MALIGNANTBRAINTUMOUR IN ADULTS
RESULTS OF RADIATION THERAPY IN PATIENTS Wrl2-1 BRAINSTEM GLIOMAS
M. Pamucka, UCzopkiewicz-RadiationTher~yDept.-Opole, POLAND
Sanz MC, Martfn M, Romero J, Regueiro CA, de la Torte A, Valc.~h'cel FJ, Magall6n R, Velasco J, and Arag6n G. Dept. of Radiation Oncology. Clinica Puerta de Hierro. Madrid. Spain
In the the years 1990-1995 in our Department we applied the large dose fraction radiotherapy with chemotherapy for GBM and AA in adults. The patients up to 60 years old with anaplastic astrocytoma and glioblastoma multiforme after paliative surgery procedure were qualified for this treatment. The chemotherapy: CCNU (120140mg/m2) was started 2-4 weeks after operation. The radiotherapy was started 10-12 days later. The patients were irradiated with the coblat unit, 6 Gy/day to the tumour bed only, twice weekly, to the total dose 42-54 Gy. After the end of the radiotherapy, the chemotherapy in the same dose every 6 weeks, to 5-6 doses at all, was continued. These treatment(RT+ChT) were applied to 24 patients with AA and 17 with GBM. Results: the average survival in the patients with AA is 27,8 months and in the patients with GBM 10,7 months. We did not state the serious side effects. Conclusions: radiotherapy with large dose fractions for the brain tumours in adults is good method. The results of this method are similar to the results of conventional radiotherapy. The mentional method is well tolerated and allows the treatment get short.
Due to the considerable hazards associated to the surgical resection of brainstem gliomas, radiotherapy remains the routinely used treatment. We evaluated the results of this treatment approach and the factors that influence the prognosis of these patients. Patients and methods: We have evaluated 48 patients with brainstem tumors treated at our department between 1965 and 1993. Nineteen patients had histological verification of tumor type 0 6 low grade and 3 high grade astrocytomas) and the diagnosis was based on clinical and radiographic findings in 27 patients. Twenty-one patients were male and 27 were female. Their median age was 9 years (range 1 to 66 years). The mean duration of symptoms was 6 months. The length of the largest diameter of the tumors varied between 2 and 8 cm (mean 4.5). Twenty-two minors (45%) involved the IV ventricle, 16 (33%) the cerebellar peduncles, and 19 (35%) involved the mecl.ulla. CSF diversions were performed in 16 patients (33%) to relieve hydrocephalus. All patients were treated using megavoltage equipment and most patients were treated using two parallel opposed lateral fields. The probabilities of relapse free survival and overall survival were calculated using the Kaplan-Meier method and differences between curves were evaluated using the log-rank test. Results: Of 48 patients, 33 (69 %) died of tumor related causes, 12 are alive without disease and 3 were lost to follow-up. The five and ten year actuarial relapse free survival probabilities were 26% and 23% respectively. The five and ten year overall survival probabilities were 2770 and 2370. The probability of survival was significantly lower in female patients and those less than ten year old. Age significantly influenced the probability of relapse free survival. Conclusions: Brainstem tumors have a poor prognosis specially in young patients.