HIGH-DOSE BCNU AND AUTOLOGOUS PROGENITOR-CELL TRANSPLANTATION GIVEN WITH INTRAARTERIAL CISPLATINUM AND SIMULTANEOUS RADIOTHERAPY IN THE TREATMENT OF HIGH-GRADE GLIOMAS - BENEFIT FOR SELECTED PATIENTS

A phase II study of postoperative high-dose carmustine (HDBCNU), intra carotid cisplatin (CDDP), and radical radiotherapy in patients with hi gh-grade glioma was performed, Patients underwent 4-6 consecutive days of blood hematopoietic progenitor cell (HPC) apheresis without prior mobilization, Chemotherapy included intracarotid CDDP, 60 mg/m2, and B CNU, 900 mg/m2, HPC were infused 48 h after HDBCNU, Whole brain irradi ation, up to 50 Gy, was started on the 8th day after HPC infusion, Wit h a median follow-up time of 44 months, median overall survival was 15 .5 months, Eight patients (23.5 %) are alive free of disease 2-6 years after treatment (seven out of 25 patients with glioblastoma multiform e and one out of nine patients with anaplastic astrocytoma), Survival was influenced by young age, good performance and complete surgical re section, Two patients (5.8%) died of therapy-related complications, Ac ute hematological toxicity of HDBCNU was moderate,,vith a full recover y on day 26, No acute pulmonary or hepatic toxicity was found, Late se vere neurological toxicity was observed in one third of patients survi ving beyond 2 years, We conclude that HDBCNU, 900 mg/m2, intracarotid CDDP and radical radiotherapy appear to benefit some patients with hig h-grade gliomas, and phase III studies should preferentially select yo ung patients with resectable tumors.