Radiotherapy combined with nimustine hydrochloride and etoposide for malignant gliomas: Results of a pilot study

Background: The aim of this study was to examine the effectiveness of radio -chemotherapy using nimustine hydrochloride (ACNU) and etoposide (VP-16) fo r malignant gliomas. Methods: From 1985 through 1998, 33 consecutive patients with supratentoria l malignant gliomas were treated by a single protocol. The mean age was 45. 8 years (range 12-76 years). The median Karnofsky performance score was 80 (range 60-100). There were 14 anaplastic astrocytomas (AA) and 19 glioblast omas (GBM). Following surgery, 60 Gy of radiotherapy combined with an adjuv ant chemotherapy using ACNU (80 mg/m(2) i.v. days 1 and 36) and etoposide ( 80 mg/m(2) i.v. days 2, 3, 37 and 38) was administered. On completion of th e initial radio-chemotherapy, a single cycle of the same chemotherapy was r epeated every 6-8 weeks until tumor progression or for 2 years at the maxim um. Results: All 33 patients tolerated treatment. We observed complete response in five cases (15%), partial response in nine (27%), no change in 11 (33%) and progressive disease in eight (24%). The response rate (>50% reduction) was therefore 42.4%. Median progression-free survival (PFS) for all 33 pat ients was 8.4 months: 7.8 months for GBMs and 13.5 months for AAs. There wa s no significant difference in PFS between GBM and AA patients (p = 0.14). The median survival time of all 33 patients was 21.1 months: 16.2 months fo r GBMs and 49.9 months for AAs. The difference in survival between AA and G BM was statistically significant (p = 0.0019). Myelosuppression appeared in 11 patients: grade 2 hematological toxicity in 10 cases (30%) and grade 3 in one case (3%). We did not observe any gastrointestinal toxicity. Multiva riate analysis showed that age and initial histological grade had independe nt prognostic significance. Conclusion: RT with ACNU and etoposide are feasible and well tolerated and the treatment results were comparable to the best results reported in the l iterature.