4521TUBIANA

Abstract. The purpose of this work was to determine the response rate and toxicity of a combination of Carmustine and The prognosis for primary brain tumors is very poor. Surgery and radiotherapy are currently the standard therapies to treat anaplastic astrocytoma (grade III) and glioblastoma multiforme (grade IV). No effective treatment is available, in spite of very active fundamental research on these tumors. Although major advances have been made in therapeutic methods such as surgery, radiotherapy, chemotherapy and various combinations, the overall prognosis for glioblastomas remains unfavorable (1,2) and the median survival time ranges from 6 to 12 months. Few patients are still alive 2 years after diagnosis. The initial therapeutic approach consists of surgical resection. It is rarely curative due to infiltration of tumor cells into the surrounding brain parenchyma and migration inside the brain. Resection represents a prognostic factor since there is a good correlation between patient survival and complete resection (3). However, resection is frequently impossible because of the volume or location of the tumor at a vital brain site. Post-operative radiotherapy produces only a minor prolongation in survival with median survival, increasing from 4.5 -6 months in the case of surgery alone to 9-10 months for a combination of surgery and post-operative radiotherapy (4). Chemotherapy has a limited impact on the survival, despite meta analyses of randomized cases which suggested a survival benefit of 5% to 10% at two years by adjuvant chemotherapy for high grade astrocytoma (5,6). Median survival increased from 9.4 to 12 months. The most commonly used chemotherapy consisted of nitrosoureas such as Carmustine (7). The timing of chemotherapy and radiotherapy is the subject of much debate. It is believed that the blood-brain barrier is more permeable to the penetration of cytotoxic drugs before radiotherapy rather than after, and that tumors are intrinsically less resistant prior to radiotherapy. However, some patients have chemoresistant tumors and therefore require early radiotherapy. We report the results of a pre-irradiation chemotherapy protocol, described first by Grossman et al. (8), used in 37 adults with a glioblastoma for whom complete resection was impossible. Planning of the protocol was based on Grossman's published results. Chemotherapy relied on a combination of 2 effective drugs: BCNU and Cisplatin. BCNU administered as single-drug therapy for postradiotherapy recurrent or progressive glioblastomas yielded a 29% response rate in glioblastomas and 64% in anaplastic astrocytomas, while the corresponding rates achieved with Cisplatin were, respectively, 73% and 83% (9). 1249 Correspondence to: N