Randomized trial of radiation therapy (RT) plus dibromodulcitol (DBD) versus RT plus BCNU in high grade astrocytoma.

Abstract

Purpose: We performed a randomized trial to comparesurvival distributions and toxicity of radiation therapy (RT)and DBD with RT and BCNU in patientswith high-grade astrocytoma. Methods: A total of 238patients with supratentorial grade 3 and grade 4astrocytoma were studied. Patients were stratified by age,extent of surgery, tumor grade, and performance scoreand randomly assigned to receive RT 55-60 Gyand either DBD, 200 mg/m² orally on Days1–10 every five weeks or BCNU, 200 mg/m²intravenously every seven weeks. Median age was 60years; 62% were 55 years or older. Eighty-threepercent had subtotal resection, 58% had grade 4tumors, and 83% had performance scores of 0–2.Results: Survival distributions for all patients in thetwo arms were similar, with median survival of41 weeks in each arm. Time to progressiondistributions were virtually identical, with medians of 22weeks. BCNU produced significantly greater hematologic toxicity; medianleukocyte and platelet nadirs on the first cyclewere 3.6 vs. 4.7 (P=0.0001) and117 vs. 162 (P < 0.0001), and overallplatelet nadirs were 80.5 vs. 114 (P =0.0019). Non-hematologic toxicities were also significantly greater withBCNU, including nausea (57% vs. 31%; P <0.0001) and vomiting (45% vs. 17%; P <0.0001). Conclusion: This trial found no evidence ofdifferences in treatment efficacy when either DBD orBCNU is combined with radiation therapy for patientswith high-grade astrocytoma.