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Phase III Trial of Carmustine and Cisplatin Compared With Carmustine Alone and Standard Radiation Therapy or Accelerated Radiation Therapy in Patients With Glioblastoma Multiforme: North Central Cancer Treatment Group 93-72-52 and Southwest Oncology Group 9503 Trials

Jan C. Buckner, Karla V. Ballman, John C. Michalak, Gary V. Burton, Terrence L. Cascino, Paula J. Schomberg, Roland B. Hawkins, Bernd W. Scheithauer, Howard M. Sandler, Randolph S. Marks, Judith R. O'Fallon

From the Mayo Clinic and Mayo Foundation, Rochester, MN; Siouxland Hematology-Oncology Associates, Sioux City, IA; Feist Weiller Cancer Center, Louisiana State University, Shreveport; Ochsner Community Clinical Oncology Program, New Orleans, LA; and the Southwest Oncology Group–University of Michigan, Ann Arbor, MI

Address reprint requests to Jan C. Buckner, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: buckner.jan{at}mayo.edu

PURPOSE: In patients with newly diagnosed glioblastoma multiforme, to determine whether cisplatin plus carmustine (BCNU) administered before and concurrently with radiation therapy (RT) improves survival compared with BCNU and RT and whether survival using accelerated RT (ART) is equivalent to survival using standard RT (SRT).

PATIENTS AND METHODS: After surgery, patients were stratified by age, performance score, extent of surgical resection, and histology (glioblastoma v gliosarcoma) and then randomly assigned to arm A (BCNU plus SRT), arm B (BCNU plus ART), arm C (cisplatin plus BCNU plus SRT), or arm D (cisplatin plus BCNU plus ART).

RESULTS: Four hundred fifty-one patients were randomly assigned, and 401 were eligible. Frequent toxicities included myelosuppression, vomiting, sensory neuropathy, and ototoxicity and were worse with cisplatin. There was no difference in toxicity between SRT and ART. Median survival times and 2-year survival rates for patients who received BCNU plus RT (arms A and B) compared with cisplatin, BCNU, and RT (arms C and D) were 10.1 v 11.5 months, respectively, and 11.5% v 13.7%, respectively (P = .19). Median survival times and 2-year survival rates for patients who received SRT (arms A and C) compared with ART (arms B and D) were 11.2 v 10.5 months, respectively, and 13.8% v 11.4%, respectively (P = .33).

CONCLUSION: Cisplatin administered concurrently with BCNU and RT resulted in more toxicity but provided no significant improvement in survival. SRT and ART produced similar toxicity and survival.

Supported in part by Public Health Service Grants No. CA-25224, CA-37404, CA-15083, CA-63826, CA-35103, CA-35272, CA-63848, CA-45450, CA-35195, CA-52352, CA-35090, CA-35101, CA-35269, CA-37417, CA-35448, CA-63844, CA-63849, CA-35113, CA-60276, CA-35415, and CA-35431.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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