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Purpose To
evaluate long-term survival in a prospective series of
patients newly diagnosed with glioblastoma
and treated with a combination of lomustine (CCNU),
temozolomide (TMZ), and radiotherapy.
Thirty-nine patients received
radiotherapy of
the tumor site only (60 Gy) and CCNU/TMZ
chemotherapy (n = 31 received standard-dose
CCNU, 100 mg/m2 on day 1 and TMZ 100 mg/m2/d
on days 2 to 6; n = 8 received
intensified-dose CCNU 110 mg/m2 on day 1 and
TMZ 150 mg/m2 on days 2 to 6) for up to
six courses.
Results In the whole cohort, the
median overall
survival (mOS) was 23.1 months; 47.4%
survived for 2 years, and 18.5% survived for 4
years. After a median follow-up of
41.5 months, mOS
had not been reached in the intensified group
and was significantly higher than in the
standard group (22.6 months; P = .024). In
the intensified group, four of eight patients survived
for at least 56 months, two of them without
recurrence. O6-methylguanine–DNA
methyltransferase (MGMT) gene promotor methylation in
the tumor tissue was associated with
significantly longer mOS (methylated, 34.3
months v nonmethylated, 12.5 months). A multivariate Cox
proportional hazard model revealed MGMT status (methylated
v nonmethylated; relative risk [RR] of death,
0.43; P = .003) and chemotherapy dose
(intensified v standard; RR, 0.37; P = .012)
as independent prognostic factors. WHO grade 4
hematoxicity was observed more frequently in
the intensified group (57% v 16%).
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