Interstitial chemotherapy plus systemic chemotherapy for glioblastoma patients: Improved survival in sequential studies

We investigated the efficacy of 3 different systemic chemotherapy regimes i n 122 patients with histologically confirmed glioblastoma, KPS > 60, age < 65. Locoregional chemotherapy was delivered to 22 patients from all three s ystemic chemotherapy groups. Chemotherapy was given before and during radio therapy, which was the same for all patients consisting of unconventional f ractionation with a break between courses. Survival (Kaplan-Meier) was significantly longer in the subgroup receiving cisplatinum plus BCNU compared to those receiving cisplatinum plus etoposid e or carboplatinum plus BCNU with median survival time 21.5 months, 15 mont hs and 15 months respectively (log rank test p = 0.01). Survival was also s ignificantly longer in patients who received locoregional therapy compared to those who received only systemic chemotherapy (21 vs 15 months, p = 0.01 ). Univariate analysis showed that age, postoperative Karnofsky status and extent of resection were not predicitve of survival in the series, although there were trends to better outcome in younger patients and those undergoi ng total/subtotal resection. Age, systemic chemotherapy type and interstitial treatment were included in a multivariate analysis, and both locoregional treatment and chemotherapy with cisplatinum plus BCNU were significantly predictive of survival [P = 0 .01]. These encouraging preliminary results suggest that further trials wit h locoregional and systemic therapy prior to radiotherapy are worth pursuin g.