State Institution "Romodanov Institute of Neurosurgery of the National Academy of Medical Sciences of Ukraine", Kyiv 04050, Ukraine.
Odesa Regional Hospital, Odesa 65025, Ukraine.
Exp Oncol. 2020 Jun;42(2):148-156. doi: 10.32471/exp-oncology.2312-8852.vol-42-no-2.14503.
To analyze retrospectively the efficacy of temozolomide (TMZ) in various treatment regimens in glioblastoma patients accounting for varying parameters of their treatment.
302 glioblastoma patients were treated at the State Institution "Romodanov Institute of Neurosurgery of the National Academy of Medical Sciences of Ukraine" from 2003 through 2017. All the patients were surgically treated. In 205 patients, the surgery was followed by adjuvant radiotherapy (RT) with concomitant TMZ (RT + TMZ group). In 97 patients, the surgery was followed by adjuvant RT only (RT group). Kaplan - Meier survival analysis with log-rank test and Cox proportional hazards regression analysis were used for comparing overall survival (OS) and recurrence-free survival (RFS) depending on the age and gender of the patients, the extent of tumor resection, the chemotherapy intensity and the type of RT.
In RT + TMZ group as a whole, OS median was 20.7 months vs 10.8 months in RT group (р < 0.0001). The RFS was 14.8 months vs 7.9 months, correspondingly (р < 0.0001).The survival did not depend on the age, gender or localization of the tumor. On the contrary, the intensity of CTX (the number of TMZ cycles in adjuvant mode), the extent of tumor resection, and the type of RT were among the factors affecting significantly OS and RFS. The improvement in OS and RFS with increasing number of the maintenance TMZ courses was more significant in the patients aged below 60. The use of stereotactic conformal mode for RT provides an advantage in the survival over the conventional RT in RT + TMZ group.
The combination of concomitant and adjuvant maintenance CTX with TMZ was the most effective CTX regimen affecting positively OS and RFS.
分析不同治疗方案中替莫唑胺（TMZ）在胶质母细胞瘤患者中的疗效，考虑到其治疗的各种参数。
2003 年至 2017 年，在乌克兰国家医学科学院罗曼诺夫神经外科研究所，对 302 名胶质母细胞瘤患者进行了回顾性分析。所有患者均接受手术治疗。在 205 例患者中，手术后继以辅助放疗（RT）和替莫唑胺（RT+TMZ 组）。在 97 例患者中，手术后继以辅助 RT（RT 组）。采用 Kaplan-Meier 生存分析和对数秩检验及 Cox 比例风险回归分析比较患者年龄和性别、肿瘤切除程度、化疗强度和 RT 类型对总生存（OS）和无复发生存（RFS）的影响。
在 RT+TMZ 组中，OS 中位数为 20.7 个月，而 RT 组为 10.8 个月（p<0.0001）。RFS 分别为 14.8 个月和 7.9 个月（p<0.0001）。生存与年龄、性别或肿瘤部位无关。相反，CTX 强度（辅助模式下 TMZ 周期数）、肿瘤切除程度和 RT 类型是影响 OS 和 RFS 的重要因素。在年龄<60 岁的患者中，增加维持 TMZ 疗程数可显著改善 OS 和 RFS。在 RT+TMZ 组中，使用立体定向适形模式进行 RT 比常规 RT 更能提高生存率。
同步和辅助维持 CTX 联合 TMZ 是最有效的 CTX 方案，可显著改善 OS 和 RFS。
