手术切除范围及辅助替莫唑胺治疗可改善儿童胶质母细胞瘤的生存率：单中心经验
Extent of surgical resection and adjuvant temozolomide improves survival in pediatric GBM: a single center experience.
作者信息
Gupta Subhash, Mallick Supriya, Benson Rony, Haresh K P, Julka Pramod Kumar, Rath Goura Kishor
机构信息
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Childs Nerv Syst. 2017 Jun;33(6):951-956. doi: 10.1007/s00381-017-3381-6. Epub 2017 Apr 19.
BACKGROUND
Pediatric glioblastoma (pGBM) is an uncommon entity. The importance of concurrent and adjuvant temozolomide is not known in this subset of patients.
METHODS
We retrospectively analyzed our database between 2000 and 2015. All patients were treated with maximally safe surgical resection. This was followed by a uniform treatment schedule of post-operative radiation with concurrent daily temozolomide at 75 mg/m. Radiation dose was 60 Gy in 30 fractions planned by 3-dimensional conformal radiotherapy. Concurrent and adjuvant temozolomide was used in all patients treated after 2007. Four weeks later, adjuvant temozolomide was started at 150 mg/m, day 1 to 5 every 28 days and escalated to 200 mg/m from the second cycle onwards if well tolerated. Log-rank test was used to compare survival distribution. The data was analyzed using SPSS (version 16).
RESULTS
Fifty-one patients were analyzed. Median age was 14 years (range: 5 to 21 years). Thirty-five males and 16 females were noted. Median symptom duration was 4 months. Twenty-eight patients underwent a gross total resection (GTR) while 17 underwent a subtotal resection; six patients underwent decompression. Thirty-three patients received concurrent chemotherapy while 27 received adjuvant chemotherapy. Median progression-free survival (PFS) was 15.1 months. One- and 3-year PFS was 54.4% and 3-year PFS was 24.6.7%. The median overall survival was 17.4 months. In univariate analysis survival was better for gross total resection (17.4 months vs. 11.5 months; p = 0.037), and significance maintained after multivariate analysis p = 0.026, HR 3.069, 95% CI 1.14-8.23. In univariate analysis, survival was better for patients receiving temozolomide but did not achieve significance. However, in multivariate analysis, use of temozolomide was associated with significantly improved survival p = 0.036, HR 3.315, 95% CI 1.07-10.19.
CONCLUSIONS
GTR improves survival significantly in pGBM. Adjuvant temozolomide may improve survival in pGBM.
背景
儿童胶质母细胞瘤（pGBM）是一种罕见的疾病。在这一患者亚组中，同步放化疗及辅助使用替莫唑胺的重要性尚不清楚。
方法
我们回顾性分析了2000年至2015年期间的数据库。所有患者均接受了最大安全限度的手术切除。随后是统一的术后放疗治疗方案，同时每日使用替莫唑胺，剂量为75mg/m²。放射剂量为60Gy，分30次给予，采用三维适形放疗计划。2007年后治疗的所有患者均使用同步和辅助替莫唑胺。四周后，辅助替莫唑胺开始使用，剂量为150mg/m²，第1至5天，每28天一个周期，若耐受性良好，从第二个周期起剂量增至200mg/m²。采用对数秩检验比较生存分布。数据使用SPSS（版本16）进行分析。
结果
共分析了51例患者。中位年龄为14岁（范围：5至21岁）。记录到35例男性和16例女性。中位症状持续时间为4个月。28例患者接受了全切除（GTR），17例接受了次全切除；6例患者接受了减压手术。33例患者接受了同步化疗，27例接受了辅助化疗。中位无进展生存期（PFS）为15.1个月。1年和3年无进展生存率分别为54.4%和24.6%。中位总生存期为17.4个月。单因素分析显示，全切除患者的生存期更好（17.4个月对11.5个月；p = 0.037），多因素分析后该显著性仍然存在，p = 0.026，HR 3.069，95%CI 1.14 - 8.23。单因素分析中，接受替莫唑胺治疗的患者生存期更好，但未达到显著性。然而，在多因素分析中，使用替莫唑胺与生存期显著改善相关，p = 0.036，HR 3.315，95%CI 1.07 - 10.19。
结论
全切除在儿童胶质母细胞瘤中显著提高生存期。辅助替莫唑胺可能改善儿童胶质母细胞瘤的生存期。
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