Fotemustine(F)/cisplatine(CDDP)/etoposide combination with brain irradiation in the treatment of non removable high grade gliomas (HGG)

Efficiency of chemotherapy (CT) on non removable HGG has not been proven an d neodjuvant brain irradiation (RT) following biopsy is the standard treatm ent We aimed to define whether combination of polychemotherapy and radiothe rapy is synergistic in non removable HGG. It has been proven that F, CDDP a nd VP16 can reach therapeutic levels in brain after intraveinous standard d ose injections. The aim of this study was to assess that (i) neoadjuvant CT is safe; (ii) feasability and efficacions of F (100 mg/m(2).d1)/CDDP (100 mg/m(2).d1- 3 TD)/VP16 (75 mg/m(2).d1-3) q21-28d regimen; (iii) Delayed RT is not unsafe: RT was performed when tumor progression or toxicity appeared . This study included 16 patients with symptomatic non removable HGG. Two of them had anaplastic gliomas and 14 glioblastomas multiforme. None of them h ad a prior chemotherapy regimen. Objective response was evaluated with CT s can or MRI during chemotherapy. Toxicity was moderate and mainly hematologi cal (grade III-IV thrombopenia = 10/67cycles; leukopenia = 13/67). Objectiv e response rates were 5/16 (31 p. 100) (CR = 1; PR = 4; Median duration of response: 20 weeks). Median survival was 55 weeks in the 14 grade IV patien ts. Three/16 patients are still alived with respectively 22, 30, 40 months survival: These results confirm the neoadjuvant chemotherapy efficacy. It m ay be a useful tool before RT for non removable HGG.