Salvage Chemotherapy in Progressive High-grade Astrocytoma

Abstract

Introduction: Despite aggressive multidisciplinary interventions, patients with high-grade astrocytomas experience tumour progression or recurrence. Treatment for this group of patients remains a formidable challenge. We describe our experience of salvage chemotherapy for these patients. Materials and Methods: A retrospective review of relevant clinical and radiographic information of patients who received at least one cycle of salvage chemotherapy for progressive high-grade astrocytoma at the National Cancer Center, Singapore, from March 2004 to September 2006, was conducted. Patients underwent regular assessment with clinical examination and magnetic resonance brain imaging to gauge response to salvage chemotherapy. Survival and progression free interval data were analysed via Kaplan-Meier method. Results: Twenty-four patients (13 glioblastomas, 11 anaplastic astrocytomas) had received chemotherapy as salvage treatment following progression of their high-grade astrocytoma. Among 20 patients assessable for tumour response, there were 4 patients with partial responses and 9 with stable responses. The 12-month survival rate for the entire group from time of onset of tumour progression was 49.6%. Eight patients had survived more than 12 months at the time of writing. Among patients with glioblastoma, the 12-month survival rate was 30% and the median survival was 11.2 months. For patients with anaplastic astrocytoma, the 12-month survival rate was 73%. Conclusion: Durable disease control and prolonged survival were seen in a significant portion of selected patients with progressive high-grade astrocytoma who received salvage chemotherapy. Key words: Glioma, Recurrence, Temozolomide

The Magnitude of Low Vision and Blindness: Association with Socio-Demographic Determinants and Ocular Pathologies Amongst Adults in Enugu, South-East Nigeria

“…This was followed by cataract (41.9% MSVI, 48.8% LVI/LB, and 9.3% TB). This is unlike the findings from the study in India by Gupta et al [34] as well as others [13,16,20,21,26] in which cataract (50.9%) was the main cause followed by un-corrected refractive error (36%) . In Nigeria, Glaucoma being more prevalent in the south-eastern part of the country dominates the scene.…”

“…This is comparable to a hospital based study in Ethiopia [17] and others from Nepal, Sri-Lanka, and India [18][19][20]14,16,9] Similar patterns were observed in Barbados Eye study, Salisbury Ophthalmology assessment study, Rotterdam study and Andhra Pradesh Eye study. [21][22][23][24][25] Age has often been associated with some common causes of blindness like cataract, glaucoma, Age Related Macular Degeneration, (ARMD)and diabetic retinopathy. Lack of comprehensive affordable eye care as part of healthcare package often worsens the problem of the aged which is more profound in the LMICs.…”

Immuno-PET for Glioma Imaging: An Update

“…Randomized trials have shown that chemoradiation is beneficial for glioblastoma patients. More research is currently being done to determine the role of chemotherapy for both high-grade and low-grade gliomas [22].…”

Neuro-oncology at the Crossroads

“…This issue includes timely updates of these developments. 5,6 It is clear that there is better overall patient satisfaction and possibly better patient outcomes when patients are treated in a multidisciplinary setting. Few other disciplines demonstrate this philosophy more convincingly than the neuro-oncology model.…”