Ornelas Abbie S, Porter Alyx B, Sharma Akanksha, Knox Molly G, Marks Lisa A, Wingerchuk Dean M, O'Carroll Cumara B
Departments of Neurology.
Library service, Division of Education Administration, Mayo Clinic, Scottsdale, AZ.
Neurologist. 2019 Mar;24(2):71-73. doi: 10.1097/NRL.0000000000000222.
Alternating electrical fields can disrupt mitosis leading to apoptosis of rapidly dividing cancer cells. The device that utilizes this mechanism is known as tumor-treating fields (TTFields). TTFields can be applied by ceramic transducer arrays on a shaved scalp to deliver the alternating electric activity to patients with glioblastoma (GBM). It has FDA approval for use in both recurrent and newly diagnosed GBM. The objective is to critically appraise the current evidence for the use of TTFields as adjunctive treatment to newly diagnosed GBM. The objective was addressed through the development of a structured, critically appraised topic. We incorporated a clinical scenario, background information, a structured question, literature search strategy, evidence summary, clinical bottom lines, and expert discussion. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of neurooncology. A randomized controlled trial was selected for critical appraisal. Patients with newly diagnosed GBM completing standard radiation and chemotherapy with temozolomide (TMZ) were subsequently randomized to receive maintenance TMZ with TTFields, or TMZ alone. With the addition of TTFields, median progression-free survival was 6.7 months compared with 4 months without the addition of TTFields (95% confidence interval, 0.52-0.76; P<0.001) and overall survival was 20.9 months compared with 16.0 months without the addition of TTFields (95% confidence interval, 0.53-0.76; P<0.001). TTFields may increase both progression-free and overall survival in patients receiving standard chemoradiation therapy for GBM.
交变电场可扰乱有丝分裂，导致快速分裂的癌细胞凋亡。利用这一机制的设备被称为肿瘤治疗电场（TTFields）。TTFields可通过陶瓷换能器阵列应用于剃光的头皮上，将交变电活动传递给胶质母细胞瘤（GBM）患者。它已获得美国食品药品监督管理局（FDA）批准，可用于复发性和新诊断的GBM。目的是严格评估将TTFields用作新诊断GBM辅助治疗的现有证据。通过制定一个结构化的、经过严格评估的主题来实现这一目标。我们纳入了一个临床病例、背景信息、一个结构化问题、文献检索策略、证据总结、临床要点和专家讨论。参与者包括顾问和住院神经科医生、医学图书馆员、临床流行病学家以及神经肿瘤学领域的内容专家。选择了一项随机对照试验进行严格评估。完成标准放疗和替莫唑胺（TMZ）化疗的新诊断GBM患者随后被随机分为接受TTFields联合维持TMZ治疗组或单纯TMZ治疗组。加入TTFields后，无进展生存期的中位数为6.7个月，而未加入TTFields时为4个月（95%置信区间，0.52 - 0.76；P<0.001），总生存期为20.9个月，而未加入TTFields时为16.0个月（95%置信区间，0.53 - 0.76；P<0.001）。对于接受GBM标准放化疗的患者，TTFields可能会提高无进展生存期和总生存期。
