gms | German Medical Science

Objective: Despite recent advances in neurosurgery and adjuvant radio-chemotherapy, the treatment of intracranial gliomas remains challenging. Chemotherapy is a first- or second-line therapeutic option in a subset of patients, both at the onset of disease and with progression or recurrence. The alkylating agent BCNU (carmustine) has been reported to be an effective therapeutic option. However, its preference to other nitrosoureas such as ACNU remains controversial due to the potential development of pulmonary fibrosis. Therefore, the aim of the present study was to quantify side effects of chemotherapy with BCNU in the treatment of intracranial gliomas.

Methods: From 1992 until 2006, data of patients treated at our department for de novo, progressed or recurrent intracranial gliomas were collected in a data bank and were retrospectively evaluated with respect to potential side effects of BCNU application that were classified according to the National Cancer Institute (NCI) Common Toxicity Criteria (CTC) version 2.0.

Results: In the above mentioned period, 260 patients with newly diagnosed, progressed or recurrent intracranial gliomas were treated with chemotherapy at our department. 168 patients (male:female = 111:56; mean age: 45.23±13.04 years) received BCNU at a mean total dose of 1731.6±883,17 g during 1 to 11 treatment cycles. Indications for BCNU were mainly progressed or recurrent glioblastoma multiforme (n=90), oligodendrogliomas (n=40), mixed gliomas (17) and astrocytomas WHOII and III (n=21). Chemotherapy with BCNU was generally well tolerated. 88 patients developed side effects (SE) with °I SE occurring in 82, °II SE in 26, °III SE in 9 and °IV SE in 4 patients. SE included nausea and vomiting, fatigue, myelosuppression (leukopenia/thrombopenia/anemia; n=76 patients) and the development of a clinically relevant pulmonary fibrosis in one patient that resulted in BCNU-related death.

Conclusions: In our retrospective analysis of 260 patients treated with chemotherapy for intracranial gliomas, BCNU administered to 168 patients turned out to be a well tolerated cytostatic agent with mostly mild side effects. Contrary to the literature, the most dreaded side effect, a clinically relevant pulmonary fibrosis, was detected in one patient only. Therefore, the use of BCNU as a second line chemotherapy might be preferred over more aggressive cytostatic agents in terms of safety and quality of life. However, efficacy of treatment with BCNU still needs to be evaluated in our patient collective.