Wagner Sabine, Warmuth-Metz Monika, Emser Angela, Gnekow Astrid-K, Sträter Ronald, Rutkowski Stefan, Jorch Norbert, Schmid Hans-J, Berthold Frank, Graf Norbert, Kortmann Rolf-D, Pietsch Thorsten, Sörensen Norbert, Peters Ove, Wolff Johannes E A
Department of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder Klinik St. Hedwig, Regensburg, Germany.
J Neurooncol. 2006 Sep;79(3):281-7. doi: 10.1007/s11060-006-9133-1. Epub 2006 Apr 6.
Pontine gliomas are the subgroup of brainstem gliomas with the worst prognosis. Controversial treatment approaches are discussed.
Data of children with pontine gliomas treated in different prospective multi-center studies who were registered in the HIT-GBM database were pooled and analyzed addressing prognostic factors and the relevance of intensive treatment using contingency tables, Kaplan-Meier curves and Cox regression analyses.
From 1983 to 2001, 153 patients (74 males, 79 females, mean age: 8.1 years) with pontine gliomas were registered. Twenty-one tumors were low-grade and 60 were high-grade gliomas (72 undefined histology: 67 no surgery, 5 incomplete data). Sixteen tumors were partially resected, and 125 were irradiated. Ninety children received chemotherapy according to the "HIT-GBM" protocols ("Hirntumor-Glioblastoma multiforme"). The one-year overall survival rate (1YOS) of all patients with pontine glioma was 39.9+/-4.3%. None of the surviving patients had an observation time longer than 3.9 years. Favorable prognostic factors seemed to be age younger than 4 years, low-grade histology and smaller tumor. All three major treatment modalities including resection, irradiation and chemotherapy had prognostic relevance in univariable analysis. Chemotherapy remained beneficial, even if the analysis was restricted to the subgroup of irradiated tumors (1YOS 45.8+/-5.4% vs. 34.4+/-13.5%, P=0.030).
Irradiation is an effective element for the treatment of pontine gliomas. Intensive chemotherapy seems to be important in achieving a better OS.
桥脑胶质瘤是脑干胶质瘤中预后最差的亚组。目前对其治疗方法存在争议。
汇总并分析在HIT-GBM数据库中注册的不同前瞻性多中心研究中接受治疗的桥脑胶质瘤患儿的数据,采用列联表、Kaplan-Meier曲线和Cox回归分析来探讨预后因素及强化治疗的相关性。
1983年至2001年,共登记了153例桥脑胶质瘤患者(男74例,女79例,平均年龄:8.1岁)。21例为低级别肿瘤,60例为高级别胶质瘤(72例组织学未明确:67例未手术,5例数据不完整)。16例肿瘤部分切除,125例接受放疗。90名儿童按照“HIT-GBM”方案(“脑肿瘤-多形性胶质母细胞瘤”)接受化疗。所有桥脑胶质瘤患者的1年总生存率(1YOS)为39.9±4.3%。所有存活患者的观察时间均未超过3.9年。有利的预后因素似乎包括年龄小于4岁、低级别组织学和较小的肿瘤。在单变量分析中,包括切除、放疗和化疗在内的所有三种主要治疗方式均与预后相关。即使将分析局限于接受放疗的肿瘤亚组,化疗仍然有益(1YOS 45.8±5.4%对34.4±13.5%,P = 0.030)。
放疗是治疗桥脑胶质瘤的有效手段。强化化疗对于改善总生存期似乎很重要。