Valeriani Maurizio, Ferretti Antonio, Franzese Pietro, Tombolini Vincenzo
Operative Unit of Radiation Oncology, S. Salvatore Hospital, L'Aquila, Italy.
Anticancer Res. 2006 May-Jun;26(3B):2429-35.
Despite advances in the surgical, radiotherapeutic and chemotherapeutic fields, the outcome for patients with high-grade gliomas remains poor. Our experience of patients treated with and without chemotherapy is reported.
From April 1999 to July 2003, 30 patients with high-grade gliomas were treated: 13 received adjuvant radiotherapy (RT) alone whereas 17 received temozolomide 75 mg/m2/d during the irradiation time and 200 mg/m2 daily per 5 consecutive days, every 28 days for three to six cycles, starting 4 weeks after the end of radiotherapy.
The median follow-up was 12.5 months. The median overall survival (OS) was 15 months. In patients treated with RT plus chemotherapy, no statistical difference was observed between those who had undergone partial surgical resection and those with total resection (p=0.5128). In patients with glioblastoma multiforme (GBM) treated with combined radiochemotherapy, the median OS was 18 months, while it was 7 months (p=0.0204) in those treated without chemotherapy. Multivariate analysis (Cox model) evidenced statistical differences for performance status (p =0.002) and for the type of adjuvant therapy (p=0.006).
Radio-chemotherapy plus adjuvant temozolomide seemed to offer the best results in patients not submitted to debulking surgery. The performance status remained the most important prognostic factor. Tolerance to the combined regimen was very good.
尽管在外科手术、放射治疗和化学治疗领域取得了进展，但高级别胶质瘤患者的预后仍然很差。本文报告了我们对接受和未接受化疗的患者的治疗经验。
1999年4月至2003年7月，对30例高级别胶质瘤患者进行了治疗：13例仅接受辅助放疗（RT），而17例在放疗期间接受替莫唑胺75mg/m²/天，放疗结束4周后开始每28天连续5天每天200mg/m²，共进行三至六个周期。
中位随访时间为12.5个月。中位总生存期（OS）为15个月。在接受放疗加化疗的患者中，部分手术切除患者和全切除患者之间未观察到统计学差异（p=0.5128）。在接受联合放化疗的多形性胶质母细胞瘤（GBM）患者中，中位OS为18个月，而未接受化疗的患者中位OS为7个月（p=0.0204）。多变量分析（Cox模型）显示，功能状态（p =0.002）和辅助治疗类型（p=0.006）存在统计学差异。
对于未进行减瘤手术的患者，放化疗加辅助替莫唑胺似乎能提供最佳效果。功能状态仍然是最重要的预后因素。联合治疗方案的耐受性非常好。
