Reevaluation of procarbazine for the treatment of recurrent malignant central nervous system tumors

Article Abstract:

Nitrosourea analogs are the most effective chemical agents available for the treatment of tumors within the central nervous system. Tumor cells that survive initial treatment are likely to provide the source for the growth of a new tumor resistant to nitrosourea drugs; the chances for another positive response are poor. Procarbazine, a methylhydrazine derivative, has often been used in combination with other agents in the treatment of recurrent brain tumors, but has rarely been evaluated by itself as a single agent. Published reports on the efficacy of procarbazine against recurrent tumors are inconsistent. The effectiveness of procarbazine was evaluated in a group of 99 patients with recurrent primary brain tumors. This evaluation was not part of an established protocol; procarbazine was simply given to patients who were ineligible for other protocols or who refused other treatment options. For patients with glioblastoma multiforme, procarbazine temporarily stopped tumor progression in 27 percent of the cases; about 28 percent of other anaplastic gliomas were similarly halted. The median times to progression were 30 and 49 weeks, respectively. The observed duration of response was comparable to previous reports for procarbazine, however, the percentage of patients responding or stabilizing was less in this study. Nevertheless, procarbazine does provide a bit of efficacy against brain tumors which have recurred after previous treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Chemotherapy, Procarbazine hydrochloride, Procarbazine

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Malignant astrocytic gliomas in children

Article Abstract:

The evaluation of treatment alternatives is more difficult with less common tumors, as there is often an insufficient base of evidence from which to make therapeutic decisions. Brain tumors are the single most common solid tumors in children, but less than half are astrocytic gliomas (tumors composed of star-shaped neurological cells). Roughly 10 percent of these will be high-grade or malignant gliomas, which suggests an incidence of about 60 malignant astrocytic gliomas per year among children in the United States. To provide a basis for discussion of prognosis and optimum treatment, the cases of 54 children with malignant astrocytoma or glioblastoma multiforme were reviewed. The overall five-year survival was four percent for glioblastoma multiforme and 36 percent for malignant astrocytoma. At follow-up at 10 years, none of the patients with glioblastoma multiforme were surviving, compared with 32 percent survival of the malignant astrocytoma patients. There was a strong correlation between survival and the radiation dose received during treatment. Patients receiving larger doses (54 to 60 Gy) had a better chance of survival than those receiving smaller doses (35 to 50 Gy). Patients with tumors in the cerebellum or the cerebral cortex had better survival rates than those with tumors deeper in the brain. Six of the 11 patients who survived for more than five years had intellectual, emotional, or hormonal abnormalities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer in children, Childhood cancer

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Poorly differentiated gliomas of the cerebellum: a study of 18 patients

Article Abstract:

Poorly differentiated gliomas of the central nervous system are an uncommon type of tumor. Consequently, less is known about their general characteristics and optimum treatment than is known about neoplasms that occur more frequently. In a review of 18 patients with poorly differentiated gliomas of the cerebellum, five patients had glioblastoma multiforme, nine had anaplastic astrocytomas, and four had mixed malignant gliomas. Ten of the 18 patients have died, after a median survival of 32 months. The eight remaining patients are alive without evidence of tumor progression after a median follow-up period of 27.5 months. Five patients experienced metastatic spread; in three this involved the leptomeningeal sheath covering the brain, and in two the metastasis involved other regions of the brain outside the cerebellum. One patient experiencing metastatic spread, in this case to the leptomeninges, remains alive. The patients were all treated with surgical debulking. Sixteen patients received additional radiotherapy, and sixteen received chemotherapy. The experience with these patients suggests that high-dose radiation with a field limited to the primary site is the strategy of choice in the management of these tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gliomas

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