The Prognostic Impact of Addition of Adjuvant Temozolomide after Radiotherapy for Patients with Anaplastic Astrocytoma

Abstract

The current study is a retrospective one carried out in Ain-Shams Center of clinical Oncology and Nuclear Medicine , Faculty of medicine, Ain Shams University between the period of 1st January 2009 till August 31 2014, where 50 medical records were planned to be analyzed, from which 10 records were not included in analysis (3 records weren’t available in the archive, 7 contained inadequate data )and 40 were analyzed , from which 28 records were for patients, who received radiotherapy followed by temozolomide , while 12 records belonged to those patients, who received radiotherapy alone. All 40 eligible patients fulfilling the inclusion criteria and received radiotherapy (60 Grey over 30 fractions) once daily for five days/week for six weeks . In radiotherapy and temozolomide group patients received also temozolomide after radiotherapy for at least 6 cycles (dose 175mg/m^2/day for 5days of a 28-day treatment cycle ). The study regimen proved to be quite tolerable with no grade 4 toxicities detected. Hematological toxicities were tolerable and the most common was leukopenia , it was the second most common in radiotherapy and temozolomide group. The estimate mean progression free survival was (9.42) months in radiotherapy group and was(14.57) months in temozolomide and radiotherapy group . The median time to progression was 10.5 monthsfor radiotherapy group and 12.5 for TZM and radiotherapy group. The estimate mean overall survival was (12.42) months in radiotherapy group and was(18.18) months in temozolomide and radiotherapy group . The median time to death was 17 monthsfor radiotherapy group and 20 months for TZM and radiotherapy group. To summarize, the treatment of AA as for all high-grade gliomas (HGG) is unsatisfying. Current therapies are only modestly effective, and there is a limited consensus on therapy for either initial treatment or recurrent disease. Adding TZM in recurrent cases of AA and in newly diagnosed GBM cases open the way for trials to evaluate TZM in adjuvant sitting of AA patients.