Petersdorf S H, Livingston R B
University of Washington, Seattle.
J Neurooncol. 1994;20(2):155-63. doi: 10.1007/BF01052725.
Conventional treatment of malignant high grade gliomas includes maximal resection followed by external beam radiotherapy. The addition of adjuvant chemotherapy has provided little improvement in the median duration of survival for these patients, particularly those patients with glioblastoma multiforme. The failure of conventional dose chemotherapy to improve the outcome of patients with high grade brain tumors has led several investigators to utilize high dose chemotherapy in order to overcome the limited benefit seen with conventional dose therapy which is due to intrinsic drug resistance as well as the impermeability of blood brain barrier. The majority of published studies utilizing this approach suggest that the addition of high dose chemotherapy with bone marrow transplant is of marginal benefit. However, most of these trials include small numbers of patients with advanced, refractory disease. A few trials have been reported utilizing high dose therapy in an adjuvant setting and the data from these studies are somewhat more promising. This review will analyze these studies and also discuss possible modifications of this approach in order to improve this aggressive treatment for patients who otherwise would have a dismal prognosis.
恶性高级别胶质瘤的传统治疗方法包括最大限度切除肿瘤，随后进行外照射放疗。辅助化疗的加入对这些患者的中位生存期改善甚微，尤其是多形性胶质母细胞瘤患者。传统剂量化疗未能改善高级别脑肿瘤患者的治疗结果，这促使一些研究人员采用高剂量化疗，以克服传统剂量治疗中由于内在耐药性以及血脑屏障的不透性而产生的有限益处。大多数发表的采用这种方法的研究表明，高剂量化疗联合骨髓移植仅具有边际效益。然而，这些试验大多纳入的是晚期难治性疾病患者，数量较少。有少数试验报道了在辅助治疗中使用高剂量疗法，这些研究的数据更具前景。本综述将分析这些研究，并讨论这种方法可能的改进，以便改善这种对预后不佳患者的积极治疗。
