Combined radio- and chemotherapy of brain tumours in adult patients

Abstract

In order to examine the current standards of care regarding combined radio- and chemotherapy for adult patients with brain tumours, a review was carried out of recent studies examining surgery, radiotherapy and chemotherapy in high-grade glioma, medulloblastoma and primary central nervous system lymphoma. The integration of the oral cytotoxic agent temozolomide into current treatment protocols of postoperative combination therapy with radiation and drugs in high-grade glioma is discussed. In glioblastoma, the landmark phase III trial by the European Organisation for Research and Treatment of Cancer and the National Cancer Institute of Canada has defined the current standard of care. Attempts to optimise the schedule of temozolomide administration and to combine this regimen with additional agents are currently ongoing. Additional trials are examining whether temozolomide-radiotherapy combination regimens should also be the standard of care in patients with anaplastic glioma. The role of postsurgery procarbazine, lomustine, and vincristine (PCV) in addition to radiotherapy in anaplastic glioma with oligodendroglial features is controversial, as two randomised trials failed to show improved survival, despite longer progression-free survival. In medulloblastoma, no comparable landmark trial exists and therefore combined radiochemotherapy must be considered investigational. In primary central nervous system lymphoma, high-dose methotrexate-based chemotherapy is the cornerstone of therapy and the value of consolidation radiotherapy for patients achieving a complete response is controversial, even in younger patients who have a lower risk of neurotoxicity than older patients. The challenges associated with brain tumour treatment remain formidable, but rationally designed clinical trials are gradually leading to improved outcomes.