Adjuvant chemotherapy with nitrosourea compounds following surgery plus radiotherapy in glioblastoma multiforme

Although malignant gliomas have traditionally been the most frequent indication for neurosurgery, the only surgical progress in the past 20 years has been the reduction of operative morbidity and mortality. RT following surgery affects survival favorably for only a few months. Neither surgery nor RT appears to influence the course of glioblastomas, and this leaves to chemotherapy an open field for the evaluation of possible clinical activity. At present, nitrosourea compounds appear moderately effective as a palliative treatment of recurrent disease but cannot successfully replace postoperative RT. The results available would indicate that CCNU and BCNU have slightly improved the overall survival. The apparent discrepancy on survival among available series treated with a combined modality approach is most probably due to patient selection and extent of surgery. Although single-agent treatment with modest improvement may be understandable, experience in other tumor areas indicates more strongly the need for combination chemotherapy as adjuvant treatment in the future, even if multiple-agent chemotherapy has not proved superior to nitrosoureas used as single agents in advanced glioblastomas.