Conventional radiotherapy combined with carbogen breathing and nicotinamide for malignant gliomas

Maazen, R.W.M. van der; Thijssen, H.O.M.; Kaanders, Johannes H.A.M.; Köster, A.; Keyser, A.; Prick, M. J. J.; Grotenhuis, J. André; Wesseling, Pieter; Kogel, Albert J. van der

doi:10.1016/0167-8140(95)01534-n

Cited by 41 publications

(14 citation statements)

References 21 publications

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“…In our experience, with doses of 6 g/day or 80 mg/kg/day, nausea and vomiting occurred frequently and necessitated discontinuation o f the drug in 26%) o f patients. Gastrointestinal symptoms were also reported in other clinical pilot studies: three of six pa tients with head and neck cancer [30], two of six patients with breast cancer [23], and in two o f 16 patients with malignant gliomas [28]. The mechanism by which these symptoms are produced is not clear: there may be a sys temic effect or topical irritation o f the gastrointestinal mucosa.…”

Section: Discussionmentioning

confidence: 81%

Radiotherapy with carbogen breathing and nicotinamide in head and neck cancer: feasibility and toxicity

Kaanders

Pop

Marres

et al. 1995

Radiotherapy and Oncology

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The feasibility and early toxicity of radiotherapy with carbogen breathing and nicotinamide was tested in 74 head and neck cancer patients, Forty patients with laryngeal and hypopharyngeal tumors were treated with an accelerated schedule combined with car bogen alone (16) or with carbogen and nicotinamide (24). Thirty-four patients with far advanced unresectable tumors of the oral cavity and oropharynx received conventional radiotherapy with carbogen [16] or with carbogen and nicotinamide (18), Some enhancement of skin reaction was observed with nicotinamide but this remained well within limits of tolerance. With the accelerated regimen there was increased severity of mucosal damage expressed as confluent mucositis in 95% of patients which required healing times of 3 -4 months in four patients. Eventually restoration of the mucosal lining was complete in all cases. Nausea and vomiting are the most frequent side effects of nicotinamide and were reported by 60% and 36% of the subjects, respectively. In 26% this was reason to discontinue drug intake. Severe renal dysfunction was associated with nicotinamide intake in two patients of this study and in one other patient who presented later. It is our conclusion that radiotherapy combined with carbogen and nicotinamide is a safe treatment with manageable side effects. We recommend not to give nicotinamide concomitantly with nephrotoxic medication or to patients who have impaired renal function. Preliminary tumor control rates are encouraging and clini cal testing will be continued.

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Section: Discussionmentioning

confidence: 81%

Radiotherapy with carbogen breathing and nicotinamide in head and neck cancer: feasibility and toxicity

Kaanders

Pop

Marres

et al. 1995

Radiotherapy and Oncology

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“…Misonidazole, carbogen and nicotinamide, and halogenated pyrimidines failed to show an improvement of survival [22,24,30]. However, a meta-analysis of nine randomized clinical trials revealed that misonidazole improved 1-year survival rate by approximately 8% [13].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Hemoglobin Level Prior to Radiotherapy on Survival in Patients with Glioblastoma

et al. 2003

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“…However, outcomes in central nervous system tumors were not conclusive. During radiotherapy for HGG, carbogen breathing and nicotinamide did not show improved outcomes while, conversely, local and systemic toxicities increased [24][25][26]. Studies using hyperbaric chambers show more favorable results [27][28][29].…”

Section: Discussionmentioning

confidence: 98%

Modification of loco-regional microenvironment in brain tumors by spinal cord stimulation. Implications for radio-chemotherapy

Clavo

Robaina

Valcarcel³

et al. 2011

J Neurooncol

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The effectiveness of radiotherapy and chemotherapy in high grade gliomas (HGG) depends on tumor micro-environment. We summarize our experience of the influence of spinal cord stimulation (SCS) on this micro-environment. Patients with HGG (n = 26) were assessed pre- and post-SCS, using: (1) Doppler in middle cerebral arteries (MCA) and (2) in common carotid arteries (CCA); (3) tumor blood-flow using single photon emission computed tomography (SPECT); (4) tumor-pO(2) (mmHg) using polarographic probes (eight tumor areas from five patients); and (5) tumor glucose metabolism using (18)F-fluoro-2-deoxyglucose ((18)FDG) positron emission tomography ((18)FDG-PET). Pre-SCS: tumor blood-flow was lower (P < 0.001) than peri-tumor areas and healthy contra-lateral areas. Tumor-pO(2) was lower (P < 0.042) than healthy tissue. Tumor glucose metabolism was higher than peri-tumor areas (P = 0.017) and healthy contra-lateral areas (P = 0.048). Post-SCS: there were increases in: MCA blood-flow (P ≤ 0.002), CCA blood-flow (P ≤ 0.013), tumor blood-flow (P = 0.033), tumor glucose metabolism (P = 0.027) and tumor-pO(2) (P = 0.022). The percentage of hypoxic values decreased (P = 0.007). SCS can modify tumor micro-environment. The potential usefulness of SCS in improving the effectiveness of radio-chemotherapy in HGG needs to be evaluated.

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Conventional radiotherapy combined with carbogen breathing and nicotinamide for malignant gliomas

Cited by 41 publications

References 21 publications

Radiotherapy with carbogen breathing and nicotinamide in head and neck cancer: feasibility and toxicity

Radiotherapy with carbogen breathing and nicotinamide in head and neck cancer: feasibility and toxicity

Prognostic Impact of Hemoglobin Level Prior to Radiotherapy on Survival in Patients with Glioblastoma

Modification of loco-regional microenvironment in brain tumors by spinal cord stimulation. Implications for radio-chemotherapy

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