Concurrent modified PCV chemotherapy and radiotherapy in newly diagnosed grade IV astrocytoma

Adjuvant chemotherapy (CT) in the treatment of grade IV astrocytoma is at best modestly effective. The radiosensitizing effect of CT may confer an advantage to concurrent radiotherapy (RT) and CT. This study investigated concurrent procarbazine, lomustine, and vincristine (PCV) CT in newly diagnosed grade IV astrocytoma patients.

From 1992 to 1997, patients diagnosed with grade IV astrocytoma (Daumas-Duport criteria), Karnofsky performance score (KPS) > or =70 and age <65 were offered CT. Twenty-seven study patients received concurrent modified PCV plus partial brain RT. Twenty-seven controls treated at the same institution with cranial RT alone were matched for histology, age and KPS.

Median age was 49 years and mean KPS was 80 for both groups. Debulking operations were more frequent in study patients than controls (p = 0.034). One-year survival was 70% and 56%, while median survival was 82 weeks and 53 weeks for the study and control groups, respectively (p = 0.1554). CT complications were predominantly hematologic, grades II and III. Two patients developed febrile neutropenia; one patient died from Pneumocystis carinii pneumonia. Nausea, vomiting and allergic reactions were all grade I.

While a trend to increased survival was seen in the study, patients treated with concurrent PCV CT, this did not reach statistical significance. A phase III trial would help delineate the true effectiveness of concurrent CT in this population. Modified PCV is safe and reasonably well tolerated.