Stewart D J
Ontario Cancer Treatment and Research Foundation, Ottawa, Canada.
Cancer Treat Rev. 1989 Sep;16(3):129-60. doi: 10.1016/0305-7372(89)90007-8.
Glioblastomas and previously irradiated recurrent gliomas remain incurable. Chemotherapy is able to palliate patients by shrinking tumors, thereby improving neurological status and quality of life. Chemotherapy may also be capable of prolonging survival in some instances. The effectiveness of chemotherapy against gliomas is comparable to the efficacy of chemotherapy against many other solid tumors. When given in an adjuvant setting along with radiation postoperatively, studies suggest that the nitrosoureas, dibromodulcitol, dianhydrogalactitol, procarbazine, teniposide, dacarbazine, and cisplatin may possibly be useful, although results for many of these drugs are inconclusive. Some chemotherapy combinations also appear to be useful in an adjuvant setting, particularly BCNU plus ifosfamide, BCNU plus cisplatin, CCNU plus dibromodulcitol, and CCNU plus lonidamine. However, there is not yet conclusive evidence that combination chemotherapy is superior to single agent adjuvant chemotherapy in the treatment of gliomas. While the use of chemotherapy prior to postoperative cranial radiation is worthy of further study, it has not to date proven to be more effective than chemotherapy combined with radiation. In patients whose tumors have recurred following radiation, palliation may be achieved with the nitrosoureas, procarbazine, teniposide, and diaziquone. Cisplatin, high dose methotrexate, the interferons, and a variety of other medications also may be of use. As in the case of adjuvant chemotherapy, chemotherapy combinations for recurrent tumor have not been conclusively demonstrated to be superior to single agent treatment, although some CCNU-based combinations are of interest. Many different chemotherapy drugs have been administered by intracarotid infusion. There is a moderately high risk of serious local retinal and neurological toxicity using this approach, and efficacy has not been proven to be improved by this approach. However, further studies of intraarterial administration of chemotherapy are warranted in light of theoretical considerations, pharmacological observations of enhanced local drug concentrations, and the observation that patients who have failed the same drugs intravenously may respond when lower doses of the drug are administered intraarterially. In addition, some patients have had tumor shrinkage in the area infused while tumor has grown in other areas. Thus, while intracarotid chemotherapy must be regarded as still investigational and potentially quite toxic, further studies are indicated. High dose chemotherapy has been administered in combination with autologous bone marrow rescue. High response rates and prolonged survival durations have been reported in some instances, justifying further study despite substantial toxicity.(ABSTRACT TRUNCATED AT 400 WORDS)
胶质母细胞瘤和先前接受过放疗的复发性神经胶质瘤仍然无法治愈。化疗能够通过缩小肿瘤来缓解患者病情，从而改善神经状态和生活质量。在某些情况下，化疗或许还能延长患者生存期。化疗对神经胶质瘤的疗效与对许多其他实体瘤的疗效相当。研究表明，术后辅助放疗时联合使用亚硝基脲类、二溴卫矛醇、二去水半乳糖醇、丙卡巴肼、替尼泊苷、达卡巴嗪和顺铂可能有效，不过这些药物中许多的研究结果尚无定论。一些化疗联合方案在辅助治疗中似乎也有效果，特别是卡莫司汀（BCNU）加异环磷酰胺、卡莫司汀加顺铂、洛莫司汀（CCNU）加二溴卫矛醇以及洛莫司汀加氯尼达明。然而，尚无确凿证据表明联合化疗在治疗神经胶质瘤方面优于单药辅助化疗。虽然术后颅脑放疗前使用化疗值得进一步研究，但迄今为止尚未证明其比化疗联合放疗更有效。对于放疗后肿瘤复发的患者，使用亚硝基脲类、丙卡巴肼、替尼泊苷和二氮喹酮可能实现病情缓解。顺铂、大剂量甲氨蝶呤、干扰素以及其他多种药物也可能有用。与辅助化疗的情况一样，复发性肿瘤的化疗联合方案尚未被确凿证明优于单药治疗，尽管一些基于洛莫司汀的联合方案值得关注。许多不同的化疗药物已通过颈动脉内灌注给药。采用这种方法存在较高的严重局部视网膜和神经毒性风险，而且尚未证明这种方法能提高疗效。然而，鉴于理论考虑、局部药物浓度增加的药理学观察结果，以及静脉使用相同药物无效的患者在动脉内给予较低剂量药物时可能有反应这一观察结果，有必要对动脉内化疗进行进一步研究。此外，一些患者在灌注区域肿瘤缩小，而其他区域肿瘤却在生长。因此，虽然颈动脉内化疗仍被视为处于研究阶段且潜在毒性较大，但仍需进一步研究。大剂量化疗已与自体骨髓挽救联合应用。在某些情况下报告了较高的缓解率和延长的生存期，尽管毒性很大，但仍有理由进行进一步研究。（摘要截选至400字）
