Miglierini Petra, Bouchekoua Mohamed, Rousseau Benoit, Hieu Phong Dam, Malhaire Jean-Pierre, Pradier Olivier
Department of Radiotherapy, Institute of Oncology and Haematology, University Hospital Morvan, 2 Avenue Foch, Brest, France.
Clin Neurol Neurosurg. 2012 Nov;114(9):1222-5. doi: 10.1016/j.clineuro.2012.02.056. Epub 2012 Mar 31.
For the last few years wafers of Gliadel have been inserted into the operation cavity in patients with glioblastoma multiforme. This is followed by concurrent radio-chemotherapy with temozolomide (TMZ) according to the Stupp protocol. Only a few studies have investigated this kind of treatment regimen and the impact in terms of survival and toxicity of the combination of Gliadel with TMZ and radiotherapy.
From November 2006 to January 2010, 24 patients with a newly diagnosed glioblastoma have undergone a tumour resection which was considered to be macroscopically complete in 12 cases and with tumour residue in another 12 cases. The mean age at the moment of diagnosis was 60.25years and the median age 63. Twenty-three patients underwent subsequently concurrent radio-chemotherapy with TMZ followed by cycles of elevated doses of TMZ as an adjuvant treatment. One patient had adjuvant radiotherapy alone followed by adjuvant chemotherapy. Thirteen were able to receive 6 or more cycles of adjuvant TMZ. Seven patients had received less than 6 cycles of TMZ as an adjuvant therapy. Two patients did not receive adjuvant TMZ at all.
The median overall survival of our group was 19.2months and the median progression free survival was 12.3months. Overall survival for the macroscopically complete-resection patients was 14months, and 12.85months in subtotal-resection patients. The median OS was 14.25months for patients PS 0 - 1 at the moment of diagnosis and 12.65 for PS 2 patients. Chemotherapy with TMZ had to be stopped prematurely in 10 cases due to haematotoxicity, digestive toxicity or early relapse.
The concomitant use of surgery with implantation of BCNU wafers and radio-chemotherapy seems to be well tolerated. Despite the small number of patients treated in our group, particular attention should be paid to the potential haematological consequences of this multimodal treatment regimen.
在过去几年中，已将格利雅得（Gliadel）晶片植入多形性胶质母细胞瘤患者的手术腔中。随后根据斯图普（Stupp）方案进行替莫唑胺（TMZ）同步放化疗。仅有少数研究对这种治疗方案以及格利雅得与TMZ和放疗联合应用在生存和毒性方面的影响进行了调查。
2006年11月至2010年1月，24例新诊断的胶质母细胞瘤患者接受了肿瘤切除术，其中12例被认为在宏观上完全切除，另12例有肿瘤残留。诊断时的平均年龄为60.25岁，中位年龄为63岁。23例患者随后接受了TMZ同步放化疗，之后进行高剂量TMZ周期作为辅助治疗。1例患者仅接受辅助放疗，随后进行辅助化疗。13例患者能够接受6个或更多周期的辅助TMZ治疗。7例患者接受的辅助TMZ治疗少于6个周期。2例患者根本未接受辅助TMZ治疗。
我们组的中位总生存期为19.2个月，中位无进展生存期为12.3个月。宏观上完全切除患者的总生存期为14个月，次全切除患者为12.85个月。诊断时PS 0 - 1患者的中位总生存期为14.25个月，PS 2患者为12.65个月。由于血液毒性、消化毒性或早期复发，10例患者不得不提前停止TMZ化疗。
手术联合植入卡莫司汀（BCNU）晶片与放化疗似乎耐受性良好。尽管我们组治疗的患者数量较少，但应特别关注这种多模式治疗方案潜在的血液学后果。
