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ABSTRACT: Sixty-four adult patients with malignant glioma entered into a Phase II study on the use of accelerated hyperfractionated radiation therapy. Histology included anaplastic astrocytoma (AA) in 15 patients and glioblastoma multiforme (GBM) in 49 patients. Treatment consisted of radiation therapy doses of 66 Gy in 44 fractions in 22 treatment days in 4.5 weeks, fractions of 1.5 Gy, b.i.d. 1,3-bis(2-chlorethyl)-1-nitrosourea (BCNU) 80 mg/m2 and hydroxyurea 800 mg/m2 were both given on treatment days 1, 6, 11, 16, and 21 during the irradiation course. Median survival time for all 64 patients is 61 weeks (range; 12-163 weeks) from the date of starting irradiation. Median time to tumor progression (MTP) for GBM patients is 31 weeks, and 1-year and 3-year progression-free survival (PFS) are 16% and 0%, respectively, while MTP for AA patients is not attained yet, and 1-year and 3-year PFS are 100% and 73%, respectively. On univariate analysis of prognostic factors for GBM patients, younger age, total or subtotal tumor removal, and frontal tumor location are associated with a better prognosis. A multivariate analysis confirmed the importance of the extent of surgery and tumor site and revealed the interfraction interval (4.5-5.0 hours vs 5.5-6.0 hours, p = .041) as an important prognostic factor. Acute and late toxicity is not increased. Longer follow-up and more patients are needed to evaluate tumor control and toxicity in AA patients.
American Journal of Clinical Oncology 11/1995; 18(5):449-53. · 2.01 Impact Factor
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ABSTRACT: Forty-eight patients with malignant glioma were treated with hyperfractionated radiation therapy followed by multiagent chemotherapy to explore feasibility and toxicity of such combined modality treatment.
There were 34 males and 14 females with a median age of 53 years (range, 32-74 years) and median Eastern Cooperative Oncology Group performance status score of 1 (range, 0-3). Histology included anaplastic astrocytoma in 11 patients and glioblastoma multiforme in 37 patients. Radiation was given at 1.2 Gy per fraction, two fractions per day, for a total dose of 72 Gy, with a reduction in field size after 52.8 Gy. Four weeks after completion of hyperfractionated radiation therapy multiagent chemotherapy was introduced with bischlorethyl nitrosourea (BCNU) 50 mg/m2, days 1-3, vincristine 1.4 mg/m2 (max. 2 mg), day 1, procarbazine 50 mg/m2, days 1-7 and cisplatin 20 mg/m2, days 1-3. Cycles were repeated every 4 weeks to a maximum of six cycles or until tumor progression was noted.
Median survival time for all patients was 52 weeks (range, 16-185 weeks) and median time to tumor progression was 30.5 weeks (range, 12-131 weeks). Besides age, histology, performance status, and extent of surgery, interfraction interval and location of tumor influenced survival in glioblastoma multiforms patients on univariate analysis: Patients treated with shorter intervals (4.5-5 h) did better than those treated with longer intervals (5.5-6 h); also, glioblastoma multiforme patients with frontal tumors did better than those with tumors of the other locations. Multivariate analysis confirmed that the performance status, interfraction interval, and tumor location were significant prognostic factors in glioblastoma multiforme patients. Acute toxicity was mild. No cases of brain necroses were observed.
Hyperfractionated radiation therapy followed by multiagent chemotherapy was well tolerated with mild acute and virtually no late toxicity. More patients and longer follow-up are needed for further evaluation of its activity and late effects in anaplastic astrocytoma patients.
International Journal of Radiation OncologyBiologyPhysics 01/1995; 30(5):1179-85. · 4.11 Impact Factor
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ABSTRACT: Between 1988 and 1991, eighty-six patients with glioblastoma multiforme were evaluated in order to define the influence of extent of surgery and tumor location on treatment outcome. Patients underwent surgery followed by postoperative hyperfractionated radiotherapy and chemotherapy delivered according to one of two consecutive protocols. Surgery consisted of biopsy in 25 (29%) patients and subtotal or gross total tumor resection in 61 (71%) patients. Frontally located tumors were noted in 26 (30%) patients and other tumor locations were noted in 60 (70%) patients. Patients having more radical surgery had longer median survival time (MST) and higher 1- and 2-year survival rates than those with biopsy only (56 vs 29 weeks, respectively; 62% and 23% vs 16% and 0%, respectively; p = 0.00000). Patients having frontally located tumors had longer MST and higher 1- and 2-year survival rates than those with other tumor locations (101 vs 47 weeks, respectively; 76% and 44% vs 37% and 2.5%, respectively; p = 0.00001). Multivariate analysis confirmed that extent of surgery and tumor location were independent prognostic factors in patients with glioblastoma multiforme. Regarding progression-free survival, patients having more radical surgery had longer median time to tumor progression (MTP) than those with biopsy only (33 weeks vs 21 weeks, respectively). Also, progression-free survival at 1 year was higher in radically resected group than in biopsy only group (20% vs 0%, respectively; p = 0.00000). Patients with frontally located tumors had longer MTP (42 weeks) and higher progression-free survival at 1 year (42%) than those with other tumor location (28 weeks and 1.7%, respectively; p = 0.00002).(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Neuro-Oncology 02/1994; 21(2):177-85. · 3.21 Impact Factor
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ABSTRACT: Brachial plexus palsy due to traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Nerve transfer is the only possibility for repair in cases of spinal nerve-root avulsion. This technique was analyzed in 37 patients with 64 reinnervation procedures of the musculocutaneous and/or axillary nerve using upper intercostal, spinal accessory, and regional nerves as donors. The most favorable results, with an 83.8% overall rate of useful functional recovery, were obtained in patients with upper brachial plexus palsy in which regional donor nerves, such as the medial pectoral, thoracodorsal, long thoracic, and subscapular nerves, had been used. The overall rates of recovery for the spinal accessory and upper intercostal nerves were 64.3% and 55.5%, respectively, which are significantly lower. The authors evaluate the results of nerve transfer and analyze different donor nerves as factors influencing the prognosis of surgical repair.
Journal of Neurosurgery 03/1992; 76(2):191-7. · 2.96 Impact Factor
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ABSTRACT: The use of the accessory nerve as a donor is one of the possibilities for the reinnervation of the brachial plexus in cases of paralysis due to root avulsion. In this paper, an analysis of the reinnervation of the musculocutaneous or axillary nerve using the spinal accessory nerve is made on 13 cases, 8 of total and 5 of upper partial avulsion. In all cases, Allieu's technique was used, but in seven cases reinnervation was supplemented by upper intercostal nerves when there was total avulsion and/or by the medial pectoral nerve when there was partial avulsion. The methods are discussed and compared with the intercostobrachial anastomosis.
Surgical Neurology 02/1990; 33(1):7-11. · 1.67 Impact Factor
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ABSTRACT: The prognosis for surgical treatment in cases of upper brachial plexus palsy due to spinal roots avulsion is somewhat better than in cases of total palsy. The main reasons are better possibilities for surgical reinnervation using regional donors i.e. the medial pectoral and the thoracodorsal nerves, and a shorter time span for nerve regeneration. Regional donor nerves, alone or in combination with upper intercostals and/or the spinal accessory nerve, were used in 13 cases for the reinnervation of the musculocutaneous and/or the axillary nerves. The value of the regional donors is analysed and compared with that of the spinal accessory and intercostal nerves. The value is documented throughout the results of surgical treatment with a follow-up period of at least 18 months after surgery.
Neurological Research 10/1989; 11(3):181-5. · 1.52 Impact Factor
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ABSTRACT: In cases of brachial plexus spinal root avulsions the only possibility for surgical treatment is reinnervation of plexus by cross-anastomosis with intact nerves. As donor nerves for reinnervation the adjoining (upper intercostal and spinal accessory) or regional intact nerves can be used. In this paper an analysis of these nerves on histological preparation from 15 autopsies and analysis of surgical results from 13 operated patients with total or partial spinal root avulsions are presented. The advantages of pure motor, especially regional, nerves and possibility of combined use of all donor nerves are emphasized.
Neurological Research 07/1986; 8(2):117-22. · 1.52 Impact Factor
