Prospective study evaluating the radiosensitizing effect of reduced doses of temozolomide in the treatment of Egyptian patients with glioblastoma multiforme

Abstract

PurposeIn view of the documented toxicity of continuous daily radiosensitizer doses of temozolomide concomitant with radiation in the treatment of glioblastoma multiforme, we aimed to compare it with a different schedule of abbreviated radiosensitizer dosing.Patients and methodsThis was a randomized prospective study comparing toxicity and survival in 60 Egyptian patients with glioblastoma multiforme. Patients in arm I received temozolomide at a dose of 75 mg/m2 daily with radiotherapy for 42 days, starting 4 weeks after surgery and reaching to a total radiation dose of 60 Gy/30 Fractions/6 weeks, while patients in arm II received temozolomide at a dose of 75 mg/m2 concomitantly with the same radiotherapy schedule daily in the first and last weeks of the same radiotherapy program.ResultsCommon grade 1–2 adverse events were malaise in 28 patients (46.7%), followed by alopecia (40%) and nausea (26.7%). Grade 3–4 convulsion and decreased level of consciousness was seen in only four patients who were all from arm I. The median progression-free survival (PFS) for the entire study population was 10.6 months (95% confidence interval [CI] 7.3–14), and PFS at 12 months was 32%. The median PFS in arm I was 8.8 months (95% CI 5.9–11.7) and in arm II 11.5 months (95% CI 8.9–14.2), and PFS at 12 months for both arms was 32% and 30% respectively (P=0.571). The median overall survival (OS) of the whole group of patients was 14.2 months (95% CI 13–15.5), and OS was 70% at 12 months and 25% at 18 months. The median OS for patients in arm I was 12.3 months (95% CI 7.7–16.9), whereas in arm II it was 14.3 months (95% CI 14–14.7) (P=0.83).ConclusionReduced radiosensitizer dosing of temozolomide concomitant with radiotherapy in glioblastoma multiforme exhibited comparable efficacy with a classic continuous daily schedule, though with better tolerability.

As artérias lenticuloestriadas podem interferir na extensão da ressecção tumoral e sobrevida nos gliomas da ínsula?

“…A ressecção tumoral deve ser máxima, desde que a função neurológica não seja comprometida pela extensão da ressecção, já que confere valor prognóstico. 55 Quando a ressecção microcirúrgica não é segura, como por exemplo devido à localização do tumor ou condição clínica do paciente), biópsia deve ser realizada. 54 RNM T2 coronal (superior esquerda) e axial (superior direita) evidenciando insular esquerdo; foi optado por ressecção microcirúrgica do tumor através de abordagem transsilviana com mapeamento da cortical e subcortical com paciente acordado.…”

Irradiation facilitates the inhibitory effect of the heat shock protein 90 inhibitor NVP-BEP800 on the proliferation of malignant glioblastoma cells through attenuation of the upregulation of heat shock protein 70

“…Standard treatments for glioblastoma include surgery, radiation and chemotherapy. However, traditional surgery or radiotherapy alone is not fully effective and the median survival period of patients with brain cancer is not satisfactory ( 4 , 5 ). Radiotherapy in combination with chemotherapy has evident advantages in curing brain cancer by improving the three- to ten-year survival rates compared with those in patients treated with radiotherapy alone ( 6 ).…”