Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Seoul 463-707, Korea.
J Neurooncol. 2011 Jan;101(2):247-54. doi: 10.1007/s11060-010-0249-y. Epub 2010 Jun 5.
Malignant primary spinal cord gliomas (PSCGs) are rare, and the optimal treatment for these lesions remains controversial. We report herein treatment outcomes of six malignant PSCGs managed with temozolomide (TMZ)-based multidisciplinary treatment. TMZ was administered concomitantly with fractionated radiotherapy for two newly diagnosed primary spinal cord glioblastoma multiforme (GBM), followed by adjuvant chemotherapy with TMZ. For one anaplastic astrocytoma (AA) and one anaplastic ependymoma (AEPN), TMZ was given as adjuvant therapy at first recurrence. One malignantly transformed ependymoma (EPN) and one malignantly transformed diffuse astrocytoma (DA) were treated with TMZ after radiotherapy at second recurrence. Two patients with newly diagnosed GBM died, 12 and 16 months, respectively, after being treated with TMZ, during and after radiation therapy. One patient with AA and one with malignantly transformed EPN showed good response to salvage therapy with TMZ and had stable disease 21 and 20 months, respectively, after TMZ treatment. One patient with recurrent AEPN and one with malignantly transformed DA died from uncontrolled progression of the lesions despite TMZ chemotherapy. Three patients developed grade 1 or 2 neutropenia, anemia, and infection. Nonhematologic toxicities occurred in all patients; however, they were below grade 3 in severity. TMZ treatment may have a positive effect on control of malignant PSCGs and survival for some patients. Specifically, treatment with TMZ during and after radiation therapy might provide survival benefit to patients with primary spinal cord GBM. A multicenter cooperative investigation for a large-scale study on malignant PSCGs may be required.
原发性脊髓胶质母细胞瘤（PSCGs）罕见，这些病变的最佳治疗方法仍存在争议。我们报告了 6 例恶性 PSCG 经替莫唑胺（TMZ）为基础的多学科治疗的治疗结果。2 例新诊断的原发性脊髓胶质母细胞瘤（GBM）同时给予 TMZ 联合分割放疗，随后给予 TMZ 辅助化疗。1 例间变性星形细胞瘤（AA）和 1 例间变性室管膜瘤（AEPN）在首次复发时给予 TMZ 辅助治疗。1 例恶性转化的室管膜瘤（EPN）和 1 例恶性转化的弥漫性星形细胞瘤（DA）在第二次复发后接受放疗后给予 TMZ 治疗。2 例新诊断的 GBM 患者在接受 TMZ 联合放疗和放疗后分别于 12 个月和 16 个月死亡。1 例 AA 患者和 1 例恶性转化的 EPN 患者经 TMZ 挽救治疗后反应良好，TMZ 治疗后分别稳定 21 个月和 20 个月。1 例复发性 AEPN 患者和 1 例恶性转化的 DA 患者尽管接受了 TMZ 化疗，但病变仍无法控制进展而死亡。3 例患者发生 1 级或 2 级中性粒细胞减少症、贫血和感染。所有患者均出现非血液学毒性，但严重程度均低于 3 级。TMZ 治疗可能对控制恶性 PSCG 和某些患者的生存有积极影响。具体来说，在放疗期间和之后给予 TMZ 可能会为原发性脊髓 GBM 患者带来生存获益。可能需要进行多中心合作研究，以对恶性 PSCG 进行大规模研究。
