Combined radiotherapy and temozolomide in patients with recurrent high grade glioma.

Aims And Background: There is only little preliminary information about combined-modality treatment with radiotherapy and temozolamide. The purpose of this analysis was to document the feasibility of such combined-modality treatment.

Methods: We treated 25 patients with recurrent high grade gliomas after standard therapy (surgery and radiation) with the following schedule: 400 mg temozolomide orally for five days repeated every 28 days, and radiotherapy at a dose of 20-30 Gy (2 x 1.2 Gy per day). Four of these patients underwent a second operation without complete tumor resection.

Results: After 125 courses of temozolomide, grade 1 (NCI-CTC) thrombocytopenia was found in four patients and grade 2 in two patients. Two patients developed grade 1 leukocytopenia and two others grade 2. CTC grade 1-2 nausea was observed in eight patients. For one patient we reduced the dose of temozolomide to 300 mg/day because of thrombocytopenia. One patient discontinued therapy after the first course because of leukocytopenia and nausea. CTC grade 3-4 side effects did not occur. Combined-modality treatment showed no more side effects than treatment with temozolomide alone. The median duration of response was seven months.

Conclusion: The observed side effects were tolerable. Combined treatment with radiotherapy and temozolomide is feasible. Further investigation of this agent is necessary.