Brandes Alba A, Nicolardi Linda, Tosoni Alicia, Gardiman Marina, Iuzzolino Paolo, Ghimenton Claudio, Reni Michele, Rotilio Antonino, Sotti Guido, Ermani Mario
Department of Medical Oncology, Istituto Oncologico Veneto-IRCCS Padova, Padova, Italy.
Neuro Oncol. 2006 Jul;8(3):253-60. doi: 10.1215/15228517-2006-005. Epub 2006 May 24.
We compared survival in patients with anaplastic astrocytoma (AA) treated with adjuvant procarbazine, lomustine, and vincristine (PCV) with survival in patients treated with temozolomide. A retrospective analysis was made of patients with newly diagnosed AA treated with adjuvant postradiotherapy chemotherapy. Outcome analysis included progression-free survival and overall survival. The following prognostic factors were taken into account: patient age, extent of resection, performance status, presence of contrast enhancement in presurgical imaging, and type of adjuvant treatment. Among 109 AA patients, 49 were treated with PCV and 60 with temozolomide. The treatment groups were well matched for pretreatment characteristics, except for the presence of contrast enhancement. Age, extent of surgery, performance status, and presence of contrast enhancement were statistically significant prognostic factors according to the Cox model analysis of survival. Type of adjuvant chemotherapy was not a significant factor, either for progression-free survival or for overall survival. Hematological toxicity, nonhematological toxicity grades 3-4, and premature discontinuation due to toxicity were observed in 9%, 3% to 5%, and 37%, respectively, of cases in the PCV group versus 4% to 5%, 0, and 0, respectively, in the temozolomide group. Although the present study was not randomized, it was well designed, and it reports on two homogeneous and consecutive series of patients, for whom histology was verified to obtain survival data only for patients with AA following the recent WHO 2000 classification. Even if no survival advantage has been demonstrated for temozolomide versus PCV, we conclude that temozolomide should be preferred because of its greater tolerability.
我们比较了接受辅助性丙卡巴肼、洛莫司汀和长春新碱（PCV）治疗的间变性星形细胞瘤（AA）患者的生存率与接受替莫唑胺治疗的患者的生存率。对接受辅助性放疗后化疗的新诊断AA患者进行了回顾性分析。结果分析包括无进展生存期和总生存期。考虑了以下预后因素：患者年龄、切除范围、体能状态、术前影像学检查中有无强化以及辅助治疗类型。在109例AA患者中，49例接受了PCV治疗，60例接受了替莫唑胺治疗。除了有无强化外，治疗组在预处理特征方面匹配良好。根据生存的Cox模型分析，年龄、手术范围、体能状态和有无强化是具有统计学意义的预后因素。辅助化疗类型对于无进展生存期或总生存期均不是显著因素。PCV组分别有9%、3%至5%和37%的病例出现血液学毒性、3 - 4级非血液学毒性以及因毒性导致的提前停药，而替莫唑胺组分别为4%至5%、0和0。尽管本研究未进行随机分组，但设计良好，报告了两个同质且连续的患者系列，这些患者的组织学经过验证，仅获取了符合世界卫生组织2000年最新分类的AA患者的生存数据。即使未证明替莫唑胺相对于PCV有生存优势，但我们得出结论，由于替莫唑胺耐受性更好，应优先选择。
