Effectiveness of temozolomide treatment used at the same time with radiotherapy and adjuvant temozolomide; concomitant therapy of glioblastoma multiforme: multivariate analysis and other prognostic factors.

AIM: Prognostic factors which affect treatment results of glioblastoma multiforme (GBM; WHO Grade IV) patients has been investigated in many researches. For these patients determination of prognostic factors helps generating multimodal therapy protocols. For this purpose, in the Baskent University Medical School, Neurosurgery Clinic, Adana Medical Research Center, specific characteristics of GBM patients who have surgery retrospectively investigated and factors which affect prognosis has been determined. METHODS: Between January 2005 and January 2009, 59 patients (25 female, 34 male) who have GBM have been evaluated retrospectively. Mean follow-up period was 27.4 (+/-17.3) months. Headache (66.1%) was the most seen symptom. Time of diagnosis was 1-2 months for most of the patients (54.2%). Fifty-nine patients had 67 operations totally. Preoperative Karnofski Performance Scale (KPS) was >or=70 for 43 operations, or=70, for 26 operations KPSor=70 (P=0.0000) , postoperative KPS 2 was >or=70 (P=0.0000), type of tumor resection (P=0.00002), multiple operations (P=0.001), adjuvant RT (P=0.0000) and ConcT with adjuvant TMZ (P=0.0000) were all positive prognostic factors which extend the survival. After multivariate analysis, post operative KPS was >or=70 (P=0.003; OR:0.89; % 95 CI:0.83-0.96), type of resection (P=0.055; OR:0.37; % 95 CI:0.13-0.12) and multiple operations (P=0.042; OR:2.65; % 95 CI:1.03-6.82) were independent prognostic factors. CONCLUSION: When independent prognostic factors were examined ,median survival found out 7.8 months longer fort he patients whose postoperative KPS were >or=70, 5.7 months longer for the patients who had radical resection, 6.6 months longer for the patients who had multiple operations. Although patients who had ConcT with adjuvant TMZ had 1.7 months longer survival compared to patients who had only adjuvant RT, it was not determined as an independent prognostic factor.

The effect of concurrent androgen deprivation and 3D conformal radiotherapy on prostate volume and clinical organ doses during treatment for prostate cancer.

In this study, we investigated the shrinking effect of concurrent three-dimensional conformal radiotherapy (3D-CRT) and androgen deprivation (AD) on prostate volume, and its possible impact on the dose received by the rectum and bladder during the course of 3D-CRT. The difference between the prostatic volumes determined on pre-treatment planning CT (PL-CT) and post-treatment CT (PT-CT) following a 3D-CRT course was assessed in 52 patients with localised prostate carcinoma. The changes in mean prostate volume when compared with PL-CT and PT-CT-based measurements were assessed. The pre- and post-treatment mean prostate volumes for the whole study population were 49.7 cm(3) and 41.0 cm(3) (p _ 0.02), respectively. The study cohort was divided into two groups depending on the duration of neoadjuvant androgen deprivation (NAD): 23 patients (44.7%) were designated as "short NAD" (< or =3 months; SNAD) and the remaining 29 (55.3%) as "long NAD" (>3 months; LNAD). Patients on SNAD experienced a significantly greater reduction in prostate volume compared with those on LNAD (14.1% vs 5.1%; p _ 0.03). A significant increase in rectum V(40-60) values in PT-CT compared with PL-CT was demonstrated. LNAD patients had significantly higher rectal V(50-70) values at PT-CT compared with the SNAD group. There was a significant decline in V(30)-V(75) bladder values in PT-CT compared with PL-CT in the SNAD group. In conclusion, a higher prostate volume reduction during 3D-CRT was demonstrated when RT planning was performed within 3 months of NAD. However, this reduction and daily organ motion may lead to an unpredictable increase in rectal doses.

Urine calcium and deoxypyridinoline in assessment of response to local radiation therapy for metastatic bone disease.

To evaluate the predictability of urine calcium (Ca+2) and deoxypyridinoline (DPD) in the assessment of response to palliative radiation therapy (RT) for metastatic bone disease. Forty-two patients with osteolytic bone metastases from breast or lung primaries were enrolled in this study. Serial urine Ca+2 and DPD measurements were performed before RT, six weeks, and twelve weeks afterwards. All eligible patients received a total of 30 Gy RT in 3 Gy daily fractions. Pre-irradiation mean urine Ca+2 and DPD levels were 16 +/- 3.7 g/micromol/dL, and 89.2 +/- 61 pmol/micromol crea. Both were significantly higher than normal range. A significant correlation between pre-irradiation Ca+2 (r = 0.6, p < 0.001), DPD (r = 0.8, p < 0.001) levels and the extent of bone metastases were detected. Thirty-six patients (Group I) were alive without disease progression outside the radiation portal. Urine Ca+2 and DPD levels demonstrated a significant and progressive decrease following RT in Group I patients (p < 0.001). Clinical and radiological evaluation revealed occurrence of new bone metastases in six patients (Group II), with concurrent significant increase in concentrations of urine DPD and Ca+2 (p = 0.006 for Ca+2 and p = 0.009 for DPD, respectively). Urine Ca+2 and DPD levels can be used for assessment of response of bone to local irradiation, and are able to predict further progression of bone metastases in cancer patients.