Dr Negrín University Hospital, Las Palmas, Spain ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain GICOR (Grupo de Investigación Clínica en Oncología Radioterápica), Madrid, Spain
Dr Negrín University Hospital, Las Palmas, Spain ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain.
Integr Cancer Ther. 2014 Nov;13(6):513-9. doi: 10.1177/1534735414550037. Epub 2014 Sep 15.
Relapsed high-grade gliomas (HGGs) have poor prognoses and there is no standard treatment. HGGs have ischemia/hypoxia associated and, as such, drugs and oxygen have low access, with increased resistance to chemotherapy and radiotherapy. Tumor hypoxia modification can improve outcomes and overall survival in some patients with these tumors. In previous works, we have described that cervical spinal cord stimulation can modify tumor microenvironment in HGG by increasing tumor blood flow, oxygenation, and metabolism. The aim of this current, preliminary, nonrandomized, study was to assess the clinical effect of spinal cord stimulation during brain reirradiation and chemotherapy deployed for the treatment of recurrent HGG; the hypothesis being that an improvement in oxygenated blood supply would facilitate enhanced delivery of the scheduled therapy.
Seven patients had spinal cord stimulation applied during the scheduled reirradiation and chemotherapy for the treatment of recurrent HGG (6 anaplastic gliomas and 1 glioblastoma). Median dose of previous irradiation was 60 Gy (range = 56-72 Gy) and median dose of reirradiation was 46 Gy (range = 40-46 Gy). Primary end point of the study was overall survival (OS) following confirmation of HGG relapse.
From the time of diagnosis of last tumor relapse before reirradiation, median OS was 39 months (95% CI = 0-93) for the overall study group: 39 months (95% CI = 9-69) for those with anaplastic gliomas and 16 months for the patient with glioblastoma. Posttreatment, doses of corticosteroids was significantly decreased (P = .026) and performance status significantly improved (P = .046).
Spinal cord stimulation during reirradiation and chemotherapy is feasible and well tolerated. In our study, spinal cord stimulation was associated with clinical improvement and longer survival than previously reported in recurrent anaplastic gliomas. Spinal cord stimulation as adjuvant during chemotherapy and reirradiation in relapsed HGGs merits further research.
复发性高级别神经胶质瘤（HGG）预后较差，目前尚无标准治疗方法。HGG 存在缺血/缺氧相关问题，因此药物和氧气的摄取量较低，对化疗和放疗的抵抗力增加。肿瘤缺氧修饰可以改善某些此类肿瘤患者的预后和总生存期。在之前的工作中，我们已经描述了颈椎脊髓刺激可以通过增加肿瘤血流量、氧合和代谢来改变 HGG 的肿瘤微环境。本研究的目的是评估脊髓刺激在复发性 HGG 脑再放疗和化疗期间的临床效果，假设增加含氧血液供应将有助于增强计划治疗的递送。
7 名患者在复发性 HGG（6 例间变性神经胶质瘤和 1 例胶质母细胞瘤）的计划再放疗和化疗期间接受了脊髓刺激。先前放疗的中位剂量为 60Gy（范围=56-72Gy），再放疗的中位剂量为 46Gy（范围=40-46Gy）。研究的主要终点是复发性 HGG 确诊后的总生存期（OS）。
从最后一次肿瘤复发再放疗前的诊断时间起，整个研究组的中位 OS 为 39 个月（95%CI=0-93）：间变性神经胶质瘤为 39 个月（95%CI=9-69），胶质母细胞瘤为 16 个月。治疗后，皮质类固醇剂量显著降低（P=0.026），功能状态显著改善（P=0.046）。
脊髓刺激在再放疗和化疗期间是可行的且耐受良好。在我们的研究中，与以前报道的复发性间变性神经胶质瘤相比，脊髓刺激与临床改善和更长的生存时间相关。脊髓刺激作为复发性 HGG 化疗和再放疗的辅助手段值得进一步研究。
