Grade 2 gliomas eventually result in progressive neurological symptoms in almost all patients, causing premature death. Prior trials have demonstrated tumor regression in recurrent low-grade gliomas after the initiation of a number of chemotherapies, including regimens with procarbazine, lomustine, and vincristine1; carmustine plus interferon2; and mechlorethamine, vincristine, and procarbazine.3Similarly, the combination of procarbazine, CCNU, and vincristine (PCV), when administered as initial therapy, has been shown to result in tumor regression.4-6
A preliminary trial demonstrated improved progression-free survival in patients receiving chemotherapy and radiation therapy (RT) vs RT alone.7 Patients with supratentorial World Health Organization grade 2 low-grade gliomas, age of 18 to 39 years with subtotal resection/biopsy, or age ≥40 years with any extent resection were randomly assigned to RT alone or RT and PCV. Patients were eligible if they had supratentorial pathologically confirmed grade 2 astrocytoma, oligodendroglioma, or oligoastrocytoma. All patients had to have a Karnofsky Performance Status score of ≥60 (on a scale from 0 to 100, with lower numbers indicating greater disability) and a neurological function score of ≤3 (on a scale from 0 to 5, with lower numbers indicating better neurological function).
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