Streffer J, Schabet M, Bamberg M, Grote E H, Meyermann R, Voigt K, Dichgans J, Weller M
Department of Neurology, Medical School, University of Tübingen, Germany.
J Neurol. 2000 Apr;247(4):297-302. doi: 10.1007/s004150050587.
Oligodendroglial tumors have been identified as a subgroup of glial neoplasms with a distinctly better response to chemotherapy and overall survival than purely astrocytic gliomas. Here we report our experience with adjuvant postirradiation and preirradiation chemotherapy using procarbazine, lomustine, and vincristine (PCV) in 27 patients with WHO grade II or III oligodendroglioma or oligoastrocytoma. The efficacy of chemotherapy was assessed according to the Macdonald response criteria (complete response, CR; partial response, PR; stable disease, SD; progressive disease, PD) and progression-free survival intervals by computed tomography or magnetic resonance imaging. First, we confirm that PCV salvage therapy for patients progressing after radiotherapy is highly effective (n = 11, 1 CR, 5 PR, 5 SD; median progression-free survival has not yet been reached, but is longer than 18 months). Second, 3 patients who received radiotherapy plus PCV as first-line therapy achieved CR and 2 achieved SD, and all 5 are progression-free with a median follow-up of 12 months. Third, given these encouraging results, 11 patients received postoperative preirradiation PCV chemotherapy and were given radiotherapy only upon progression. Preirradiation PCV chemotherapy was also effective (2 CR, 3 PR, 6 SD; median progression-free survival has not been yet reached, but is longer than 14 months). Patients with anaplastic oligoastrocytomas were as likely to respond to PCV chemotherapy, as were patients with anaplastic oligodendroglioma. Three patients who had previously responded to PCV were successfully treated with a second course of PCV upon recurrence. PCV chemotherapy was also effective in patients with leptomeningeal spread of oligodendrogliomas. A randomized prospective trial is required to compare the effectiveness and neurotoxicity of first-line PCV chemotherapy followed by radiotherapy to the traditional reverse sequence.
少突胶质细胞瘤已被确定为神经胶质瘤的一个亚组，与单纯星形细胞胶质瘤相比，其对化疗的反应明显更好，总生存期也更长。在此，我们报告了27例世界卫生组织（WHO）II级或III级少突胶质细胞瘤或少突星形细胞瘤患者使用丙卡巴肼、洛莫司汀和长春新碱（PCV）进行辅助放疗后和放疗前化疗的经验。根据麦克唐纳反应标准（完全缓解，CR；部分缓解，PR；疾病稳定，SD；疾病进展，PD）以及通过计算机断层扫描或磁共振成像评估的无进展生存期来评估化疗效果。首先，我们证实，对于放疗后病情进展的患者，PCV挽救治疗非常有效（n = 11，1例CR，5例PR，5例SD；无进展生存期的中位数尚未达到，但超过18个月）。其次，3例接受放疗加PCV作为一线治疗的患者实现了CR，2例实现了SD，所有5例在中位随访12个月时均无进展。第三，鉴于这些令人鼓舞的结果，11例患者接受了术后放疗前PCV化疗，仅在病情进展时才进行放疗。放疗前PCV化疗也有效（2例CR，3例PR，6例SD；无进展生存期的中位数尚未达到，但超过14个月）。间变性少突星形细胞瘤患者对PCV化疗的反应与间变性少突胶质细胞瘤患者一样。3例先前对PCV有反应的患者在复发时成功接受了第二疗程的PCV治疗。PCV化疗对少突胶质细胞瘤软脑膜播散的患者也有效。需要进行一项随机前瞻性试验，以比较一线PCV化疗后放疗与传统相反顺序的有效性和神经毒性。
