Jeremic B, Grujicic D, Antunovic V, Djuric L, Stojanovic M, Shibamoto Y
Department of Oncology, University Hospital, Kragujevac, Yugoslavia.
Int J Radiat Oncol Biol Phys. 1994 Dec 1;30(5):1179-85. doi: 10.1016/0360-3016(94)90326-3.
Forty-eight patients with malignant glioma were treated with hyperfractionated radiation therapy followed by multiagent chemotherapy to explore feasibility and toxicity of such combined modality treatment.
There were 34 males and 14 females with a median age of 53 years (range, 32-74 years) and median Eastern Cooperative Oncology Group performance status score of 1 (range, 0-3). Histology included anaplastic astrocytoma in 11 patients and glioblastoma multiforme in 37 patients. Radiation was given at 1.2 Gy per fraction, two fractions per day, for a total dose of 72 Gy, with a reduction in field size after 52.8 Gy. Four weeks after completion of hyperfractionated radiation therapy multiagent chemotherapy was introduced with bischlorethyl nitrosourea (BCNU) 50 mg/m2, days 1-3, vincristine 1.4 mg/m2 (max. 2 mg), day 1, procarbazine 50 mg/m2, days 1-7 and cisplatin 20 mg/m2, days 1-3. Cycles were repeated every 4 weeks to a maximum of six cycles or until tumor progression was noted.
Median survival time for all patients was 52 weeks (range, 16-185 weeks) and median time to tumor progression was 30.5 weeks (range, 12-131 weeks). Besides age, histology, performance status, and extent of surgery, interfraction interval and location of tumor influenced survival in glioblastoma multiforms patients on univariate analysis: Patients treated with shorter intervals (4.5-5 h) did better than those treated with longer intervals (5.5-6 h); also, glioblastoma multiforme patients with frontal tumors did better than those with tumors of the other locations. Multivariate analysis confirmed that the performance status, interfraction interval, and tumor location were significant prognostic factors in glioblastoma multiforme patients. Acute toxicity was mild. No cases of brain necroses were observed.
Hyperfractionated radiation therapy followed by multiagent chemotherapy was well tolerated with mild acute and virtually no late toxicity. More patients and longer follow-up are needed for further evaluation of its activity and late effects in anaplastic astrocytoma patients.
对48例恶性胶质瘤患者采用超分割放射治疗，随后进行多药化疗，以探讨这种联合治疗方式的可行性和毒性。
患者中男性34例，女性14例，中位年龄53岁（范围32 - 74岁），东部肿瘤协作组中位体能状态评分为1分（范围0 - 3分）。组织学类型包括11例间变性星形细胞瘤和37例多形性胶质母细胞瘤。放疗每次剂量为1.2 Gy，每天2次，总剂量72 Gy，在52.8 Gy后缩小照射野。超分割放射治疗结束4周后开始多药化疗，卡莫司汀（BCNU）50 mg/m²，第1 - 3天；长春新碱1.4 mg/m²（最大2 mg），第1天；丙卡巴肼50 mg/m²，第1 - 7天；顺铂20 mg/m²，第1 - 3天。每4周重复1个周期，最多6个周期或直至观察到肿瘤进展。
所有患者的中位生存时间为52周（范围16 - 185周），中位肿瘤进展时间为30.5周（范围12 - 131周）。单因素分析显示，除年龄、组织学类型、体能状态和手术范围外，分次照射间隔时间和肿瘤位置影响多形性胶质母细胞瘤患者的生存：分次照射间隔时间较短（4.5 - 5小时）的患者比间隔时间较长（5.5 - 6小时）的患者预后好；此外，额叶肿瘤的多形性胶质母细胞瘤患者比其他部位肿瘤的患者预后好。多因素分析证实，体能状态、分次照射间隔时间和肿瘤位置是多形性胶质母细胞瘤患者的重要预后因素。急性毒性较轻。未观察到脑坏死病例。
超分割放射治疗后进行多药化疗耐受性良好，急性毒性较轻，几乎无晚期毒性。需要更多患者和更长时间的随访来进一步评估其对间变性星形细胞瘤患者的疗效和晚期效应。
