Sheleg Sergey V, Korotkevich Eugeny A, Zhavrid Edvard A, Muravskaya Galina V, Smeyanovich Arnold F, Shanko Yury G, Yurkshtovich Tatsiana L, Bychkovsky Pavel B, Belyaev Sergey A
Department of Chemotherapy, N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk, Belarus.
J Neurooncol. 2002 Oct;60(1):53-9. doi: 10.1023/a:1020288015457.
Glioblastoma multiforme (GBM) makes up as many as 30% of all primary brain tumors. Despite the employment of multimodal antitumor treatment, the overall survival is less than one year. Between 06/01/1998 and 06/01/2000 17 patients (Group A) with GBM (11 males, 6 females; median age 54.3 years) were administered local chemotherapy with cisplatin incorporated into biodegradable 6-carboxylcellulose polymer (cisplatin-depot (CDDP-D)). After the subtotal removal of GBM, twenty 1.5 x 1.5 cm polymer plates with a total area of 45 cm2 (the density of cisplatin immobilization on 6-carboxylcellulose being 1 mg/cm2, a total cisplatin dose of 45 mg) were implanted into the tumor bed. Group B (21 patients with GBM; 11 males, 10 females; median age 53.2 years) was control: the subtotal tumor ablation without CDDP-D implantation. Two to three weeks after the surgery all the patients of Groups A and B started a course of radiation therapy. A total dose of cranial irradiation was 20 Gy (1 fraction/day, 5 days/week; a daily dose of 2 Gy) followed by a boost tumor bed irradiation (1 fraction/day, 5 days/week; a daily dose of 2 Gy) up to the conventional dose of 60 Gy. Survival data for the patients were processed using the Kaplan-Meier method and analyzed by logrank test. All the patients of Group A tolerated surgical ablation of the brain tumor without side effects (brain edema, seizures, etc.). No patient of Group A had a reduction in blood cell counts during six weeks that would indicate systemic exposure to cisplatin. Blood chemistry and urinalysis did not show evidence of renal injury. No side effects of radiotherapy were registered in Group B either, regarding both the psychoneurological status of the patients and the basic values of homeostasis. Karnofsky performance scale (KPS) score of Group A and Group B patients demonstrated no significant differences before and after the surgery. The median overall survivals for patients of Group A and Group B were 427.5 and 211.0 days respectively (p = 0.00001; overall logrank test). Conclusion. Local chemotherapy of GBM with CDDP-D followed by irradiation is well tolerated and effective.
多形性胶质母细胞瘤（GBM）占所有原发性脑肿瘤的30%。尽管采用了多模式抗肿瘤治疗，但其总生存期仍不足一年。在1998年6月1日至2000年6月1日期间，17例GBM患者（A组，11例男性，6例女性；中位年龄54.3岁）接受了局部化疗，将顺铂掺入可生物降解的6-羧基纤维素聚合物中（顺铂储库（CDDP-D））。在GBM次全切除后，将20块1.5×1.5 cm的聚合物板（总面积45 cm²，6-羧基纤维素上顺铂固定密度为1 mg/cm²，顺铂总剂量45 mg）植入肿瘤床。B组（21例GBM患者，11例男性，10例女性；中位年龄53.2岁）为对照组：进行肿瘤次全切除但不植入CDDP-D。手术两到三周后，A组和B组的所有患者均开始进行一个疗程的放射治疗。颅脑照射总剂量为20 Gy（每天1次，每周5天；每日剂量2 Gy），随后对肿瘤床进行追加照射（每天1次，每周5天；每日剂量2 Gy），直至常规剂量60 Gy。采用Kaplan-Meier方法处理患者的生存数据，并通过对数秩检验进行分析。A组所有患者均耐受脑肿瘤手术切除，无副作用（脑水肿、癫痫等）。A组患者在六周内血细胞计数均未减少，这表明没有全身暴露于顺铂。血液化学和尿液分析未显示肾损伤迹象。B组在患者的精神神经状态和内环境稳定的基本指标方面也未出现放疗副作用。A组和B组患者的卡氏功能状态量表（KPS）评分在手术前后无显著差异。A组和B组患者的中位总生存期分别为427.5天和211.0天（p = 0.00001；总体对数秩检验）。结论。GBM采用CDDP-D局部化疗后再进行照射耐受性良好且有效。
