Department of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2010 Feb 1;116(3):705-12. doi: 10.1002/cncr.24730.
The authors hypothesized that intensified chemotherapy in protocol HIT-GBM-C would increase survival of pediatric patients with high-grade glioma (HGG) and diffuse intrinsic pontine glioma (DIPG).
Pediatric patients with newly diagnosed HGG and DIPG were treated with standard fractionated radiation and simultaneous chemotherapy (cisplatin 20 mg/m2 x 5 days, etoposide 100 mg/m2 x 3 days, and vincristine, and 1 cycle of cisplatin + etoposide + ifosfamide 1.5 g/m x 5 days [PEI] during the last week of radiation). Subsequent maintenance chemotherapy included further cycles of PEI in Weeks 10, 14, 18, 22, 26, and 30, followed by oral valproic acid.
Ninety-seven (pons, 37; nonpons, 60) patients (median age, 10 years; grade IV histology, 35) were treated. Resection was complete in 21 patients, partial in 29, biopsy only in 26, and not performed in 21. Overall survival rates were 91% (standard error of the mean [SE] +/- 3%), 56%, and 19% at 6, 12, and 60 months after diagnosis, respectively. When compared with previous protocols, there was no significant benefit for patients with residual tumor, but the 5-year overall survival rate for patients with complete resection treated on HIT-GBM-C was 63% +/- 12% SE, compared with 17% +/- 10% SE for the historical control group (P = .003, log-rank test).
HIT-GBM-C chemotherapy after complete tumor resection was superior to previous protocols.
作者假设，在 HIT-GBM-C 方案中强化化疗会增加高级别胶质瘤（HGG）和弥漫性内在脑桥胶质瘤（DIPG）患儿的生存率。
新诊断为 HGG 和 DIPG 的儿科患者接受标准分割放疗和同时化疗（顺铂 20mg/m2 x 5 天，依托泊苷 100mg/m2 x 3 天，和长春新碱，以及放疗最后一周的顺铂+依托泊苷+异环磷酰胺 1.5g/m x 5 天[PEI]1 个周期）。随后的维持化疗包括在第 10、14、18、22、26 和 30 周进行进一步的 PEI 周期，然后口服丙戊酸。
97 名（脑桥 37 例；非脑桥 60 例）患者（中位年龄 10 岁；IV 级组织学 35 例）接受了治疗。21 例患者行全切除，29 例患者行部分切除，26 例患者仅行活检，21 例患者未行手术。诊断后 6、12 和 60 个月的总生存率分别为 91%（均数标准误[SE] +/- 3%）、56%和 19%。与之前的方案相比，对于有残留肿瘤的患者没有显著获益，但在 HIT-GBM-C 方案中完全切除肿瘤的患者的 5 年总生存率为 63% +/- 12% SE，而历史对照组为 17% +/- 10% SE（P =.003，对数秩检验）。
完全肿瘤切除后的 HIT-GBM-C 化疗优于既往方案。
