Mathieu David, Fortin David
Division of Neurosurgery/Neuro-Oncology, Department of Surgery, Sherbrooke University and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Can J Neurol Sci. 2006 May;33(2):127-40. doi: 10.1017/s0317167100004881.
Malignant astrocytomas are aggressive neoplasms with a dismal prognosis despite optimal treatment. Maximal resective surgery is traditionally complemented by radiation therapy. Chemotherapy is now used on patients as initial therapy when their functional status is congruent with further treatment. The classic agents used are nitrosoureas, but temozolomide has taken the front seat recently, with recent data demonstrating increased survival when this agent is used concurrently with radiation therapy in newly diagnosed glioblastoma patients. A new class of agents, refered to as biological modifiers, are increasingly used in clinical trials in an effort to affect the intrinsic biologic aberrations harboured by tumor cells. These drugs comprise differentiation agents, anti-angiogenic agents, matrix-metalloproteinase inhibitors and signal transduction inhibitors, among others. This article reviews the standard cytotoxic agents that have been used to treat malignant astrocytomas, and the different combination regimens offering promise. In addition, recent advances with biological modifiers are also discussed.
恶性星形细胞瘤是侵袭性肿瘤，尽管进行了最佳治疗，预后仍很差。传统上，最大程度的切除性手术辅以放射治疗。当患者的功能状态适合进一步治疗时，化疗现在被用作初始治疗。常用的经典药物是亚硝基脲，但替莫唑胺最近占据了主导地位，最近的数据表明，在新诊断的胶质母细胞瘤患者中，该药物与放射治疗同时使用时可提高生存率。一类新的药物，称为生物调节剂，越来越多地用于临床试验，以影响肿瘤细胞所具有的内在生物学异常。这些药物包括分化剂、抗血管生成剂、基质金属蛋白酶抑制剂和信号转导抑制剂等。本文综述了用于治疗恶性星形细胞瘤的标准细胞毒性药物以及有前景的不同联合治疗方案。此外，还讨论了生物调节剂的最新进展。
