CARBOGEN AND NICOTINAMIDE COMBINED WITH UNCONVENTIONAL RADIOTHERAPY IN GLIOBLASTOMA-MULTIFORME - A NEW MODALITY TREATMENT

Purpose: A new radiotherapy schedule to treat glioblastoma multiforme after surgery, combining nicotinamide and carbogen. Methods and Materi als: We analyzed 36 patients with glioblastoma multiforme treated afte r surgery with radiotherapy, Nicotinamide and Carbogen as follows: 7 p atients were treated with accelerated fractionation: two fractions/day , 1.5 cGy/fraction, 6 h interval, 5 days/week, total dose 60 Gy in 4 w eeks; 8 patients were treated with the same irradiation scheduling plu s Nicotinamide at the dose of 4 g and 2 g in capsules, respectively, 1 h before the first and the second irradiation fraction; 21 patients w ere treated with accelerated radiotherapy, Nicotinamide, and Carbogen (inhaled 10 min before radiotherapy and during the whole course of irr adiation). On the basis of surgical removal our patients were subdivid ed in three groups: totally resected, with residual tumor <50%, or >50 %. Radiotherapy with accelerated fractionation was completed in the sc heduled time without side effects on the whole group of patients and C arbogen inhalation did not cause significant change of cardiopulmonar parameters. The toxicity observed was predominant in the gastrointesti nal tract and was related to Nicotinamide. Results: The median surviva l time (M.S.T.) was 10 months, as reported by others authors with conv entional treatment, but in patients without surgical residual tumor an d submitted to the complete treatment schedule, the survival at 35 mon ths was around 25%. Conclusions: We conclude that this method is feasi ble with acceptable toxicity; analyzing the survival curves appears to be a trend towards an improvement in survival in the subgroup of pati ents with gross total removal treated with the combination of Carbogen , Nicotinamide, and accelerated fractionation. (C) 1997 Elsevier Scien ce Inc.