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PubMed1975

Combined modality therapy for intracranial tumors.

Three types of tumor (supratentorial astrocytoma, medulloblastoma, and craniopharyngioma), each requiring a fundamentally different therapeutic approach, will be used to illustrate the principles and practice of combined treatment in this field. The role of radiotherapy and ways of enhancing the effect of irradiation will be considered. Attention will be given to adjuvant chemotherapy and to multiple drug regimes. Reference will be made to an early effort at immunotherapy following the initial reduction of tumor cell load by surgery and irradiation.

Antigens, Neoplasm↗
PubMed1975

Combination chemotherapy for disseminated malignant melanoma.

BCNU, hydroxyurea, and imidazole carboxamide (DTIC) were administered to 89 patients with disseminated malignant melanoma. A response rate of 27% was observed. The addition of vincristine in another 89 patients did not significantly improve the response rate (30%). This includes patients who died during or after one course of therapy (less than 28 days). If the early deaths are not considered, the over-all response rate was 38%. (he best responses occurred in patients with skin, lung, and/or lymph node involvement. Liver and brain involvement heralded poor responses. This response rate appeared to be independent of age, sex or previous therapy. Moderate and severe toxicity, predominantly nausea and vomiting, was noted in most patients. The median survival for all evaluable patients was 17 months, and was independent of the regimen used.

Adolescent↗
PubMed1975

Comparison of the combination of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and vincristine with two dose schedules of 5-(3,3-dimethyl-1-triazino) imidazole 4-carboxamide (DTIC) in the treatment of disseminated malignant melanoma.

One hundred twenty patients with inoperable metastatic malignant melanoma were randomly allocated to treatment with either a combination of BCNU 150 mg/m2 and vincristine 2 mg/m2 given every 30 days, or one of two regimens of DTIC: 300 mg/m2/day x 6 or 100 mg/m2/8 hours x 18 given every 30 days. Eight of the 51 (16%) patients who were originally treated with the BCNU and vincristine combination had 50% or more objective tumor regression, compared to 6 out of 25 (24%) patients treated with daily injections of DTIC, and 6 out of 21 (29%) patients treated with DTIC injections every 8 hours. The median duration of response to the BCNU and vincristine combination was 60 days, and the median duration of survival from initiation of treatment was 6.5 months in the responders and 3.3 months in the nonresponders. The median duration of response was 90 and 100 days for the daily and 8-hour regimens of DTIC respectively, andthe median duration of survival from commencement of treatment was 8.5 months for the responders and 3.5 months for the nonresponders. None of the 43 patients who failed to respond to the initial treatment program or whose disease progressed after initial improvement responded to the alternate treatment regimen.

Adult↗
PubMed1975

Chemotherapy of primary malignant brain tumors in children.

Numerous investigators have reported on a variety of chemotherapeutic agents tested in children suffering from recurrent medulloblastoma, brain stem glioma, and ependymoma, in efforts to improve survival and reduce morbidity. Evaluation of such studies is difficult, because there were rarely more than three or four cases of each tumor type. In medulloblastoma, 5-year survival averages 32%; recurrence follows initial therapy by months to years. The recurrence may be intracranial, spinal, or metastatic, making comparison among cases very difficult. Intrathecal methotrexate (MTX) has been successfully used to treat medulloblastoma, with responses reported in about three-fourths of the cases. Intraventricular MTX is lethal when ventricular obstruction is present. MTX has been less useful in therapy of brain stem glioma and ependymoma. BCNU and CCNU have produced responses in patients with ependymoma, medulloblastoma, and brain stem glioma. Vincristine, alone or in combination, has been useful primarily in medulloblastomas. Less experience is available with several newer methods of chemotherapy, but promising results have been reported with procarbazine, 4'-demethyl-epipodophyllotoxin-beta-D-thenylidine-glucosede (PTG, VM 26), and high dose intravenous methotrexate with citrovorum rescue. It is likely that only a nationwide cooperative effort will achieve significant improvement in the chemotherapy of malignant brain tumors in children.

Antineoplastic Agents↗