Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Department of Radiation Oncology, F-75013 Paris, France.
Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Department of Neurology Mazarin, F-75013 Paris, France.
J Clin Neurosci. 2019 Oct;68:39-44. doi: 10.1016/j.jocn.2019.07.065. Epub 2019 Aug 6.
The standard medical care of glioblastoma (GBM) patients with good performance status is based on focal brain radiotherapy (40-60 Gy) with concurrent temozolomide (TMZ) followed by adjuvant TMZ. Newly diagnosed multifocal and/or multicentric GBM (M/M GBM) cases are usually treated with TMZ alone: whole brain chemoradiotherapy (CRT) is avoided for safety reasons. To our knowledge, no study has investigated the safety and efficacy of whole-brain radiotherapy (WBRT) with concurrent TMZ in M/M GBM patients. This retrospective study sought to assess the role of WBRT associated with concurrent TMZ followed by TMZ alone in this population. Eleven patients with pathologically proven M/M GBM (≥3 lobes) were treated with WBRT between April 2009 and September 2017. The median age was 50 years [34-74]. The median dose of radiotherapy was 45 Gy at 1.8 Gy per fraction over 37 days [29-41], with concurrent daily TMZ at the dose of 75 mg/m. This treatment was followed by adjuvant monthly TMZ (150 mg/m-D1-D5). All pathology slides and radiology images were reviewed. The median overall and progression-free survival times for all patients were 10 months [4-25] and 5 months [3-21], respectively. There was no grade 3-4 toxicity due to radiotherapy. One patient stopped the TMZ during the radiochemotherapy period and 9 patients received adjuvant TMZ with a median number of 5 cycles [2-8]. Our study supports the safety and the efficacy of WBRT with TMZ in newly diagnosed M/M GBM. Larger prospective studies are needed to support our results.
患有良好表现状态的胶质母细胞瘤 (GBM) 患者的标准医疗护理基于局部脑放疗 (40-60Gy) 联合替莫唑胺 (TMZ),随后进行辅助 TMZ 治疗。新诊断的多灶性和/或多中心 GBM (M/M GBM) 病例通常单独使用 TMZ 治疗:出于安全原因,避免全脑放化疗 (CRT)。据我们所知,尚无研究调查过在 M/M GBM 患者中使用 TMZ 联合全脑放疗 (WBRT) 的安全性和有效性。这项回顾性研究旨在评估在该人群中 WBRT 联合 TMZ 随后单独使用 TMZ 的作用。2009 年 4 月至 2017 年 9 月期间,11 例经病理证实的 M/M GBM (≥3 个脑叶) 患者接受了 WBRT 治疗。中位年龄为 50 岁 [34-74]。放疗的中位剂量为 45Gy,分割剂量为 1.8Gy/次,共 37 天[29-41],同时每日给予 TMZ 剂量为 75mg/m2。随后进行辅助每月 TMZ(150mg/m2-D1-D5)治疗。所有病理切片和影像学图像均进行了回顾。所有患者的中位总生存期和无进展生存期分别为 10 个月 [4-25] 和 5 个月 [3-21]。无因放疗引起的 3-4 级毒性。1 例患者在放化疗期间停止使用 TMZ,9 例患者接受了辅助 TMZ 治疗,中位治疗周期数为 5 个周期 [2-8]。我们的研究支持在新诊断的 M/M GBM 中使用 WBRT 联合 TMZ 的安全性和有效性。需要更大规模的前瞻性研究来支持我们的结果。