Chiang Kuo-Liang, Chang Kai-Ping, Lee Yi-Yen, Huang Pin-I, Hsu Ting-Rong, Chen Yi-Wei, Chang Feng-Chi, Wong Tai-Tong
Departments of Pediatrics, Kuang-Tien General Hospital, Taichung, Taiwan.
Childs Nerv Syst. 2010 Aug;26(8):1035-41. doi: 10.1007/s00381-010-1106-1. Epub 2010 Mar 10.
The purpose of this study was to assess the efficacy of TMZ on diffuse brainstem glioma, either concomitant with radiotherapy or as an adjuvant treatment after radiotherapy in children.
Eighteen children (median age at diagnosis was 8.3 years) meet the following criteria: (1) newly diagnosed diffuse brainstem glioma; (2) aged less than 18 years old, which were treated with TMZ at Taipei Veterans General Hospital from January 2004 to December 2008. They were divided into two groups according to treatment modalities: a radiotherapy alone followed by adjuvant TMZ (RT+TMZ) group received conventional radiation after initial diagnosis, and a concomitant chemoradiotherapy followed by adjuvant TMZ (CCRT+TMZ) group received concurrent chemotherapy during radiation with TMZ (75 mg/M(2)/day). After completion of the radiotherapy, TMZ (150 mg/M(2)) was administered once per day for five consecutive days for all enrolled patients in each 28-day cycle. We evaluated the progression-free survival in both groups of patients.
There were 10 patients in RT+TMZ group and eight in CCRT+TMZ group. All patients experienced progression of disease. Twelve patients (75%) died, and all deaths were attributed to the disease progression. The median progression-free survival (PFS) was 7.4 months for the RT+TMZ group and 6.4 months for the CCRT+TMZ group. The 6-month and 1-year PFS in the RT+TMZ group were 70% (SD 14%) and 30% (SD 14%), respectively, and in the CCRT+TMZ group, they were 50% (SD 17%) and 0%, respectively. The log-rank test in PFS between the two groups was not statistically significant.
In this study, CCRT with TMZ followed by adjuvant TMZ did not result in a better outcome when compared with RT alone followed by adjuvant TMZ. In addition, TMZ either as adjuvant therapy or as CCRT did not improve the prognosis of the patients with newly diagnosed diffuse brainstem glioma.
本研究旨在评估替莫唑胺（TMZ）对儿童弥漫性脑干胶质瘤的疗效，包括与放疗联合使用或作为放疗后的辅助治疗。
18名儿童（诊断时的中位年龄为8.3岁）符合以下标准：（1）新诊断的弥漫性脑干胶质瘤；（2）年龄小于18岁，于2004年1月至2008年12月在台北荣民总医院接受TMZ治疗。根据治疗方式将他们分为两组：单纯放疗后辅助TMZ（RT+TMZ）组在初诊后接受常规放疗，同步放化疗后辅助TMZ（CCRT+TMZ）组在放疗期间与TMZ（75mg/M²/天）进行同步化疗。放疗结束后，每组所有入组患者在每28天周期内连续5天每天给予TMZ（150mg/M²）。我们评估了两组患者的无进展生存期。
RT+TMZ组有10名患者，CCRT+TMZ组有8名患者。所有患者均出现疾病进展。12名患者（75%）死亡，所有死亡均归因于疾病进展。RT+TMZ组的中位无进展生存期（PFS）为7.4个月，CCRT+TMZ组为6.4个月。RT+TMZ组的6个月和1年PFS分别为70%（标准差14%）和30%（标准差14%），CCRT+TMZ组分别为50%（标准差17%）和0%。两组之间PFS的对数秩检验无统计学意义。
在本研究中，与单纯放疗后辅助TMZ相比，同步放化疗联合TMZ后辅助TMZ并未带来更好的结果。此外，TMZ作为辅助治疗或同步放化疗均未改善新诊断的弥漫性脑干胶质瘤患者的预后。
