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01.08.2015 | Original Article

Adjuvant temozolomide-based chemoradiotherapy versus radiotherapy alone in patients with WHO III astrocytoma

The Mainz experience

verfasst von: Dr. med. Arnulf Mayer, Dr. med. Carina Schwanbeck, Univ.-Prof. Dr. med. Clemens Sommer, Dr. med. Marcus Stockinger, Univ.-Prof. Dr. med. Alf Giese, Dr. med. Mirjam Renovanz, Univ.-Prof. Dr. med. Peter Vaupel, Univ.-Prof. Dr. med. Heinz Schmidberger

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 8/2015

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Abstract

Background

It is currently unclear whether adjuvant therapy for WHO grade III anaplastic astrocytomas (AA) should be carried out as combined chemoradiotherapy with temozolomide (TMZ)—analogous to the approach for glioblastoma multiforme—or as radiotherapy (RT) alone.

Patients and methods

A retrospective analysis of data from 90 patients with AA, who were treated between November 1997 and February 2014. Assessment of overall (OS) and progression-free survival (PFS) was performed according to treatment categories: (1) 50 %, RT + TMZ according to protocol, (2) 11 %, RT + TMZ with dose reduction, (3) 26 %, RT alone, and (4) 13 %, individualized, primarily palliative therapy. No dose reduction was necessary in the RT alone group.

Results

Median OS was 85, 69, and 43 months for treatment categories 1/2, 3, and 4, respectively. These differences were not statistically significant. PFS was 35, 29, 48, and 33 months for categories 1, 2, 3, and 4, respectively; again without significant differences between categories. In a subgroup of 39 patients with known IDH1 R132H status, the presence of this mutation correlated with significantly longer OS (p = 0.01) and PFS (p = 0.002). Complete or partial tumor resection and younger age also correlated with a significantly better prognosis, and this influence persisted in multivariate analysis. In the IDH1 R132H subgroup analysis, only this marker retained an independent prognostic value.

Discussion and conclusion

A general superiority of combined chemoradiotherapy compared to RT alone could not be demonstrated. Biomarkers for predicting the benefits of combination therapy using RT and TMZ are needed for patients with AA.

Cairncross G, Wang M, Shaw E et al (2013) Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 31:337–343PubMedCentralPubMedCrossRef

Combs SE, Nagy M, Edler L et al (2008) Comparative evaluation of radiochemotherapy with temozolomide versus standard-of-care postoperative radiation alone in patients with WHO grade III astrocytic tumors. Radiother Oncol 88:177–182PubMedCrossRef

Curran WJ Jr, Scott CB, Horton J et al (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85:704–710PubMedCrossRef

Grimm SA, Pfiffner TJ (2013) Anaplastic astrocytoma. Curr Treat Options Neurol 15:302–315PubMedCrossRef

Kizilbash SH, Giannini C, Voss JS et al (2014) The impact of concurrent temozolomide with adjuvant radiation and IDH mutation status among patients with anaplastic astrocytoma. J Neurooncol 120:85–93PubMedCrossRef

Kopecký J, Priester P, Slováček L et al (2010) Aplastic anemia as a cause of death in a patient with glioblastoma multiforme treated with temozolomide. Strahlenther Onkol 186:452–457PubMedCrossRef

Rogne SG, Konglund A, Scheie D et al (2014) Anaplastic astrocytomas: survival and prognostic factors in a surgical series. Acta Neurochir (Wien) 156:1053–1061CrossRef

Schemper M, Smith TL (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17:343–346PubMedCrossRef

Scoccianti S, Magrini SM, Ricardi U et al (2012) Radiotherapy and temozolomide in anaplastic astrocytoma: a retrospective multicenter study by the Central Nervous System Study Group of AIRO (Italian Association of Radiation Oncology). Neuro Oncol 14:798–807PubMedCentralPubMedCrossRef

10.

Shonka NA, Theeler B, Cahill D et al (2013) Outcomes for patients with anaplastic astrocytoma treated with chemoradiation, radiation therapy alone or radiation therapy followed by chemotherapy: a retrospective review within the era of temozolomide. J Neurooncol 113:305–311PubMedCrossRef

11.

Stewart LA (2002) Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 359:1011–1018PubMedCrossRef

12.

Stupp R, Mason WP, Van Den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996PubMedCrossRef

13.

Tanaka S, Meyer FB, Buckner JC et al (2012) Presentation, management, and outcome of elderly patients with newly-diagnosed anaplastic astrocytoma. J Neurooncol 110:227–235PubMedCrossRef

14.

Tham CK, See SJ, Tan SH et al (2013) Combined temozolomide and radiation as an initial treatment for anaplastic glioma. Asia Pac J Clin Oncol 9:220–225PubMedCrossRef

15.

Van den Bent MJ, Brandes AA, Taphoorn MJ et al (2013) Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol 31:344–350PubMedCrossRef

16.

Walker MD, Alexander E, Hunt WE et al (1978) Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333–343PubMedCrossRef

17.

Walker MD, Strike TA, Sheline GE (1979) An analysis of dose-effect relationship in the radiotherapy of malignant gliomas. Int J Radiat Oncol Biol Phys 5:1725–1731PubMedCrossRef

18.

Wick W, Hartmann C, Engel C et al (2009) NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol 27:5874–5880PubMedCrossRef

Titel: Adjuvant temozolomide-based chemoradiotherapy versus radiotherapy alone in patients with WHO III astrocytoma
The Mainz experience
verfasst von: Dr. med. Arnulf Mayer
Dr. med. Carina Schwanbeck
Univ.-Prof. Dr. med. Clemens Sommer
Dr. med. Marcus Stockinger
Univ.-Prof. Dr. med. Alf Giese
Dr. med. Mirjam Renovanz
Univ.-Prof. Dr. med. Peter Vaupel
Univ.-Prof. Dr. med. Heinz Schmidberger
Publikationsdatum: 01.08.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 8/2015
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0855-x

Springer Medizin

Adjuvant temozolomide-based chemoradiotherapy versus radiotherapy alone in patients with WHO III astrocytoma

The Mainz experience