Survival following adjuvant PCV or temozolomide for anaplastic astrocytoma

Abstract

We compared survival in patients with anaplastic astrocytoma (AA) treated with adjuvant procarbazine, lomustine, and vincristine (PCV) with survival in patients treated with temozolomide. A retrospective analysis was made of patients with newly diagnosed AA treated with adjuvant postradiotherapy chemotherapy. Outcome analysis included progression-free survival and overall survival. The following prognostic factors were taken into account: patient age, extent of resection, performance status, presence of contrast enhancement in presurgical imaging, and type of adjuvant treatment. Among 109 AA patients, 49 were treated with PCV and 60 with temozolomide. The treatment groups were well matched for pretreatment characteristics, except for the presence of contrast enhancement. Age, extent of surgery, performance status, and presence of contrast enhancement were statistically significant prognostic factors according to the Cox model analysis of survival. Type of adjuvant chemotherapy was not a significant factor, either for progression-free survival or for overall survival. Hematological toxicity, nonhematological toxicity grades 3-4, and premature discontinuation due to toxicity were observed in 9%, 3% to 5%, and 37%, respectively, of cases in the PCV group versus 4% to 5%, 0, and 0, respectively, in the temozolomide group. Although the present study was not randomized, it was well designed, and it reports on two homogeneous and consecutive series of patients, for whom histology was verified to obtain survival data only for patients with AA following the recent WHO 2000 classification. Even if no survival advantage has been demonstrated for temozolomide versus PCV, we conclude that temozolomide should be preferred because of its greater tolerability.

Revisiting anaplastic astrocytomas I: An expansive growth pattern is associated with a better prognosis

“…Lack of enhancement in anaplastic astrocytomas was first noted in a series of CT scans (30) and more recently with MRI scans (9,13,31,32). More recently, Tortosa et al (10) demonstrated contrast enhancement within anaplastic astrocytoma as a negative prognostic indicator, as did a study by Brandes et al (12). On the other hand, a recent study by Keles et al (11) did not find preoperative gadolinium enhancement to be predictive of survival in patients with anaplastic astrocytoma, but did find that a larger burden of postoperative contrast enhancement did portend a poorer outcome.…”

Dynamic 18F‐FET PET in suspected WHO grade II gliomas defines distinct biological subgroups with different clinical courses

“…Subject to the condition of a predominance of astrocytomas in the analyzed study cohort, we anticipated-in accordance with more recently published studies of grade II/grade III gliomas-2-years PFS in the range of 75-80% and 30% for those with increasing and decreasing TAC. 28,31,32 We defined the sample size of the study presuming cautiously an unadjusted hazard ratio of at least 2 for gliomas exhibiting decreasing TAC to experience tumor progression. Given an accrual period of 36 months and a follow-up time of at least 20 months (for those without progression), a sample size of at least 36 tumors in each TAC group would allow demonstrating the prognostic influence of increasing versus decreasing TAC patterns with a statistical power of 80%.…”

Diffusely infiltrating astrocytomas: pathology, molecular mechanisms and markers

“…PCV or RT ? TMZ was observed either in a retrospective study [15] or in the NOA-04 trial [154]. Despite these observations, RT ?…”