DeAngelis Lisa M
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Semin Oncol. 2003 Dec;30(6 Suppl 19):15-8. doi: 10.1053/j.seminoncol.2003.11.037.
The current standard of care for patients with high-grade glioma is resection followed by radiotherapy. Adjuvant chemotherapy is not widely accepted because of the low sensitivity of gliomas to traditional antineoplastic agents, the poor penetration of most drugs across the blood-brain barrier, and the significant systemic toxicity associated with current agents. However, nitrosoureas and, subsequently, temozolomide (Temodar [US], Temodal [international]; Schering-Plough Corporation, Kenilworth, NJ), a novel alkylating agent, cross the blood-brain barrier and have activity against gliomas. Nitrosoureas have been studied in phase III trials in the adjuvant setting. In individual trials, chemotherapy did not increase median survival but did increase the proportion of patients surviving >/=18 months by 15%. Only with large meta-analyses did the addition of chemotherapy achieve a statistically significant improvement in median survival. Currently there is no means of identifying which patients will benefit from adjuvant chemotherapy, but nitrosoureas and temozolomide are well tolerated in most patients, justifying the administration of adjuvant chemotherapy to all newly diagnosed patients with malignant glioma.
目前，高级别胶质瘤患者的标准治疗方案是手术切除后进行放疗。由于胶质瘤对传统抗肿瘤药物的敏感性较低、大多数药物难以穿透血脑屏障以及现有药物存在显著的全身毒性，辅助化疗尚未被广泛接受。然而，亚硝基脲类药物以及随后出现的新型烷化剂替莫唑胺（美国商品名Temodar，国际商品名Temodal；先灵葆雅公司，新泽西州肯尼尔沃思）能够穿越血脑屏障并对胶质瘤具有活性。亚硝基脲类药物已在辅助治疗的III期试验中进行了研究。在个别试验中，化疗并未提高中位生存期，但确实将存活≥18个月的患者比例提高了15%。只有通过大型荟萃分析，辅助化疗才在中位生存期方面取得了具有统计学意义的改善。目前尚无办法确定哪些患者将从辅助化疗中获益，但大多数患者对亚硝基脲类药物和替莫唑胺耐受性良好，这使得对所有新诊断的恶性胶质瘤患者进行辅助化疗具有合理性。
