COMBINATION CHEMOTHERAPY WITH CARMUSTINE AND CISPLATIN BEFORE, DURING, AND AFTER RADIOTHERAPY FOR ADULT MALIGNANT GLIOMAS

Twenty-two patients, aged 16 to 67, who had malignant gliomas after su rgical resection were treated with carmustine and cisplatin intravenou s infusion before, during, and after radiotherapy. All patients had su btotal or total resection, or biopsy as the initial procedure. Twenty- one patients who had at least 2 cycles of chemotherapy and finished th e whole course of radiotherapy were considered to be evaluable for res ponses. Among them, 5 had glioblastoma multiforme, 16 had anaplastic a strocytoma. The median time to tumor progression was 35 weeks (range 1 2-130 weeks) and median survival time was 66 weeks (range 10-156 weeks ). Early progression occurred more frequently in patients with biopsy only and subtotal resection, and in patients with glioblastoma than in those with anaplastic astrocytoma. This combined modality treatment p rogram was associated with reversible hematologic toxicity which was s evere in 2 patients, and with ototoxicity in 1 patient, nephrotoxicity in 2 patients. Combination of carmustine and cisplatin with cranial i rradiation for malignant gliomas is moderately toxic and appears to of fer no obvious survival advantage compared with radiation therapy plus BCNU alone.