Introduction: Despite aggressive multidisciplinary interventions, patients with high-grade astrocytomas experience tumour progression or recurrence. Treatment for this group of patients remains a formidable challenge. We describe our experience of salvage chemotherapy for these patients. Materials and Methods: A retrospective review of relevant clinical and radiographic information of patients who received at least one cycle of salvage chemotherapy for progressive high-grade astrocytoma at the National Cancer Center, Singapore, from March 2004 to September 2006, was conducted. Patients underwent regular assessment with clinical examination and magnetic resonance brain imaging to gauge response to salvage chemotherapy. Survival and progression free interval data were analysed via Kaplan-Meier method. Results: Twenty-four patients (13 glioblastomas, 11 anaplastic astrocytomas) had received chemotherapy as salvage treatment following progression of their high-grade astrocytoma. Among 20 patients assessable for tumour response, there were 4 patients with partial responses and 9 with stable responses. The 12-month survival rate for the entire group from time of onset of tumour progression was 49.6%. Eight patients had survived more than 12 months at the time of writing. Among patients with glioblastoma, the 12-month survival rate was 30% and the median survival was 11.2 months. For patients with anaplastic astrocytoma, the 12-month survival rate was 73%. Conclusion: Durable disease control and prolonged survival were seen in a significant portion of selected patients with progressive high-grade astrocytoma who received salvage chemotherapy.
High-grade astrocytoma includes glioblastoma multiforme (GBM) (World Health Organization grade 4) and anaplastic astrocytoma (AA) (WHO grade 3). These are the more common gliomas in adults.1 Treatment of these highly aggressive neoplasms remains a challenge. The infiltrative nature of astrocytoma or location of tumour in the eloquent brain precludes a surgical cure. Radical radiation therapy and chemotherapy render tumour control for a variable period. When therapy fails, tumours progressively enlarge in size or recur, frequently in or adjacent to the initial location. Hau et al2 reported a retrospective study of comparable patients with progressive high-grade astrocytoma that showed improved survival for patients who received re-intervention compared to those who received only symptomatic or palliative treatments.2 Control of tumour is also important to reduce destruction of normal brain by tumour, minimise its accompanying neurologic morbidity and subsequent negative impact on quality of life.3,4 However when tumour progresses, additional surgical and radiotherapy options are limited. Salvage chemotherapy is a controversial option. While some patients may substantially benefit from salvage chemotherapy, others may experience significant toxicity. Also, the optimal salvage chemotherapeutic regimen has yet to be identified. We describe our experience with salvage chemotherapy in patients whose high-grade astrocytoma had progressed or recurred following initial standard treatment.
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