Pace A, Vidiri A, Galiè E, Carosi M, Telera S, Cianciulli A M, Canalini P, Giannarelli D, Jandolo B, Carapella C M
Department of Neuroscience, Regina Elena National Cancer Institute, Rome, Italy.
Ann Oncol. 2003 Dec;14(12):1722-6. doi: 10.1093/annonc/mdg502.
The optimal treatment for low-grade glioma (LGG) is still controversial. Recent data indicate a potential influence of chemotherapy on the natural evolution of these tumors, allowing for the deferral of more aggressive therapies.
Forty-three patients affected with LGG (29 astrocytoma, four oligodendroglioma and 10 mixed oligo-astrocytoma) were treated with temozolomide (TMZ) at the time of documented clinical and radiological progression. McDonald's response criteria were utilized to evaluate TMZ activity. Thirty patients (69.7%) had previously received radiotherapy; 16 (37.2%) had received prior chemotherapy. Clinical benefit was evaluated measuring seizure control, reduction in steroid dose and modification of Karnofsky performance status and Barthel index. Quality of life was assessed with the QLQ-C30 questionnaire.
We observed a complete response in four patients, 16 partial responses, 17 stable disease (with four minor response) and six progressive disease. Median duration of response was 10 months [95% confidence interval (CI) 8-12], with a 76% rate of progression free survival (PFS) at 6 months, and a 39% rate of PFS at 12 months. A relevant clinical benefit was observed particularly in patients presenting epilepsy.
The high response rate of 47% (95% CI 31% to 61%) confirms that TMZ chemotherapy is a valid option in the treatment of progressive LGG. The present preliminary results seem interesting and warrant further evaluation of TMZ clinical activity in a larger series of progressive LGG.
低级别胶质瘤（LGG）的最佳治疗方案仍存在争议。近期数据表明化疗对这些肿瘤的自然病程可能有影响，从而可以推迟采用更积极的治疗方法。
43例LGG患者（29例星形细胞瘤、4例少突胶质细胞瘤和10例少突-星形细胞瘤混合型）在记录到临床和影像学进展时接受替莫唑胺（TMZ）治疗。采用麦克唐纳反应标准评估TMZ活性。30例患者（69.7%）先前接受过放疗；16例（37.2%）先前接受过化疗。通过测量癫痫控制情况、类固醇剂量减少情况以及卡氏功能状态评分和巴氏指数的变化来评估临床获益。使用QLQ-C30问卷评估生活质量。
我们观察到4例患者完全缓解，16例部分缓解，17例病情稳定（其中4例有轻微反应），6例病情进展。中位缓解持续时间为10个月[95%置信区间（CI）8 - 12]，6个月时无进展生存期（PFS）率为76%，12个月时PFS率为39%。尤其在患有癫痫的患者中观察到了显著的临床获益。
47%（95%CI 31%至61%）的高缓解率证实TMZ化疗是进展性LGG治疗中的一个有效选择。目前的初步结果似乎很有意义，值得在更大系列的进展性LGG中进一步评估TMZ的临床活性。
