High-grade astrocytoma treated concomitantly with estramustine and radiotherapy

Area of Science:

• Neuro-oncology
• Clinical Oncology
• Radiotherapy Research

Background:

• Estramustine phosphate (Estracyt) has shown promise in early investigations for malignant glioma treatment.
• Malignant gliomas, particularly astrocytoma grades III and IV, remain challenging to treat effectively.

Purpose of the Study:

• To compare the efficacy of estramustine phosphate plus radiotherapy versus radiotherapy alone as a first-line treatment for astrocytoma grades III and IV.
• To evaluate survival rates and time to progression in patients with malignant glioma receiving combined therapy.

Main Methods:

• An open randomized clinical trial involving 122 eligible patients with astrocytoma grades III and IV.
• Patients received either radiotherapy alone or estramustine orally (280 mg twice daily) for 3 months concurrently with and after radiotherapy (total 56 Gy).
• Follow-up included survival time and quality of life assessment using the EORTC QLQ-protocol.

Main Results:

• No statistically significant differences in overall survival or time to progression were found between the estramustine + radiotherapy group and the radiotherapy alone group for either grade III or IV astrocytoma.
• A trend towards improved median survival (17.3 vs. 10.6 months) and time to progression (10.1 vs. 6.5 months) was observed in grade III astrocytoma patients receiving estramustine.
• The treatment regimen was generally well-tolerated, with mild to moderate nausea being the most common side effect of estramustine.

Conclusions:

• Adding estramustine phosphate to conventional radiotherapy did not demonstrate a significant survival benefit for patients with astrocytoma grades III and IV.
• A potential positive trend in survival and progression-free survival was noted for estramustine in combination with radiotherapy for grade III astrocytoma.
• Further research may be warranted to explore the role of estramustine in specific glioma subtypes.