Brandes Alba A
Medical Oncology Department, Azienda Ospedale-Università, Padova, Italy.
Semin Oncol. 2003 Dec;30(6 Suppl 19):4-9. doi: 10.1053/j.seminoncol.2003.11.028.
The incidence of primary brain tumors has rapidly increased in recent years. The current standard of care for patients with high-grade malignant glioma is resection followed by radiotherapy. However, the use of adjuvant chemotherapy and the standard of care at first relapse are still under debate for patients with glioblastoma multiforme and anaplastic astrocytoma. Meta-analyses have suggested that adjuvant chemotherapy, specifically with nitrosourea-based regimens, is associated with improved survival. However, no randomized, controlled trial has shown a clear advantage for adjuvant chemotherapy in these patients. Cumulative toxicity associated with both radiotherapy and chemotherapy, as well as resistance to nitrosourea-based regimens related to exposure in the adjuvant setting, prevent the use of radiotherapy and nitrosourea-based regimens at first relapse. The combination of procarbazine, carmustine, and vincristine (PCV) has shown activity at first relapse in patients who have not received adjuvant chemotherapy. Temozolomide (Temodar [US], Temodal [international]; Schering-Plough Corporation, Kenilworth, NJ) has shown activity at both first and second relapse in patients who have received prior nitrosourea-based regimens. The better safety profile of temozolomide suggests that it may be preferred to PCV for treatment of patients with recurrent high-grade malignant glioma. Additional randomized, controlled trials are needed to fully define the best option for first-line chemotherapy in both the adjuvant and recurrent settings in patients with high-grade malignant glioma.
近年来，原发性脑肿瘤的发病率迅速上升。目前，高级别恶性胶质瘤患者的标准治疗方案是手术切除后进行放疗。然而，对于多形性胶质母细胞瘤和间变性星形细胞瘤患者，辅助化疗的使用以及首次复发时的标准治疗方案仍存在争议。荟萃分析表明，辅助化疗，特别是基于亚硝基脲的方案，与生存率提高相关。然而，尚无随机对照试验表明辅助化疗对这些患者有明显优势。放疗和化疗相关的累积毒性，以及辅助治疗中与暴露相关的对基于亚硝基脲方案的耐药性，使得在首次复发时无法使用放疗和基于亚硝基脲的方案。丙卡巴肼、卡莫司汀和长春新碱（PCV）联合用药在未接受辅助化疗的患者首次复发时显示出活性。替莫唑胺（美国的Temodar，国际的Temodal；先灵葆雅公司，新泽西州肯尼沃思）在接受过基于亚硝基脲方案治疗的患者首次和第二次复发时均显示出活性。替莫唑胺更好的安全性表明，在治疗复发性高级别恶性胶质瘤患者时，它可能比PCV更受青睐。需要更多的随机对照试验来全面确定高级别恶性胶质瘤患者辅助和复发情况下一线化疗的最佳选择。
