van den Bent Martin J
Department of Neurology/Neuro-Oncology Unit, Daniel den Hoed Cancer Center, PO Box 5201, 3008AE, Rotterdam, The Netherlands.
Semin Oncol. 2003 Dec;30(6 Suppl 19):39-44. doi: 10.1053/j.seminoncol.2003.11.024.
For the last three decades surgery and radiotherapy have been the mainstay of treatment for patients with low-grade gliomas, despite a lack of support from randomized controlled trials. Recent developments in our knowledge of low-grade tumor chemosensitivity and the approval of temozolomide for treatment of gliomas have led to increased interest in chemotherapy for treating low-grade gliomas. Despite challenges, including response assessment and appropriate patient selection, several phase II studies investigating chemotherapeutic treatment of low-grade gliomas have yielded promising results. Although most of these phase II studies are of limited sample size, they have shown that chemotherapy might induce clinically relevant responses and disease stabilization in patients with low-grade gliomas. As expected, low-grade oligodendroglioma is sensitive to chemotherapy, but responses were also seen in astrocytic tumors. Randomized, controlled studies should be conducted to determine the clinical significance of responses observed in phase II studies and to assess time to progression. Two randomized, controlled studies are currently investigating chemotherapy in the treatment of low-grade gliomas. Although it will take years before the data are available, these studies will help define the role of chemotherapy in the treatment of low-grade gliomas. Perhaps then we can answer the question, can chemotherapy replace radiotherapy in low-grade gliomas?
在过去三十年里，手术和放疗一直是低级别胶质瘤患者的主要治疗手段，尽管缺乏随机对照试验的支持。近年来，我们对低级别肿瘤化疗敏感性的认识有所进展，且替莫唑胺已获批用于治疗胶质瘤，这使得人们对低级别胶质瘤的化疗兴趣增加。尽管存在包括疗效评估和合适患者选择等挑战，但多项研究低级别胶质瘤化疗治疗的II期研究已取得了有前景的结果。虽然这些II期研究大多样本量有限，但它们表明化疗可能会在低级别胶质瘤患者中诱导出临床相关的反应并使疾病稳定。不出所料，低级别少突胶质细胞瘤对化疗敏感，但星形细胞瘤也有反应。应开展随机对照研究，以确定II期研究中观察到的反应的临床意义，并评估疾病进展时间。目前有两项随机对照研究正在调查化疗在低级别胶质瘤治疗中的作用。尽管要数年之后才能获得数据，但这些研究将有助于明确化疗在低级别胶质瘤治疗中的作用。也许届时我们就能回答这个问题：化疗能否在低级别胶质瘤治疗中取代放疗？
