Gaya A, Rees J, Greenstein A, Stebbing J
Department of Radiotherapy, Hammersmith Hospitals NHS Trust, Fulham Palace Road, London W6 8RF, UK.
Cancer Treat Rev. 2002 Apr;28(2):115-20. doi: 10.1053/ctrv.2002.0261.
Gliomas are the most common primary intracerebral tumours and over 60% of these are malignant. Standard treatment in the UK for patients with a good performance status consists of surgery and postoperative radiotherapy, however, recurrence is almost inevitable. Treatment of recurrent malignant gliomas (MG) is limited to further surgery, chemotherapy and novel biological therapies. The response rate to standard chemotherapy protocols for recurrent MG is less than 30%. Temozolomide (Temodar-US, Temodal-Rest of World) is an oral alkylating agent with a similar chemical structure to dacarbazine, and has recently been licensed in the UK for second line treatment of recurrent MG. Several phase II studies and one randomised trial suggest that Temozolomide improves time to progression and quality of life but not overall survival. The drug is well tolerated with dose limiting myelosuppression and thrombocytopenia occurring in less than 10% of patients at current dosage schedules. A randomised trial comparing Temozolomide with best first line adjuvant chemotherapy (PCV) is about to start recruiting patients. Further clinical studies investigating its role in neoadjuvant treatment or in combination with radiotherapy or other chemotherapeutic approaches are ongoing.
神经胶质瘤是最常见的原发性脑肿瘤，其中60%以上为恶性。在英国，对于身体状况良好的患者，标准治疗包括手术和术后放疗，然而，复发几乎不可避免。复发性恶性神经胶质瘤（MG）的治疗仅限于进一步手术、化疗和新型生物疗法。复发性MG对标准化疗方案的缓解率低于30%。替莫唑胺（美国的Temodar，世界其他地区的Temodal）是一种口服烷化剂，其化学结构与达卡巴嗪相似，最近在英国已被批准用于复发性MG的二线治疗。几项II期研究和一项随机试验表明，替莫唑胺可改善疾病进展时间和生活质量，但不能提高总生存率。该药物耐受性良好，按照当前给药方案，剂量限制性骨髓抑制和血小板减少症在不到10%的患者中出现。一项比较替莫唑胺与最佳一线辅助化疗（PCV）的随机试验即将开始招募患者。正在进行进一步的临床研究，以调查其在新辅助治疗中的作用或与放疗或其他化疗方法联合使用的情况。
