Lesser G J, Grossman S A
Johns Hopkins Oncology Center, Baltimore, MD 21287.
Cancer Treat Rev. 1993 Jul;19(3):261-81. doi: 10.1016/0305-7372(93)90038-s.
Adult patients with primary malignant brain tumors are a heterogeneous group. Most patients will have high-grade astrocytomas and can be expected to obtain minimal benefit from current standard chemotherapy regimens. Intra-arterial chemotherapy, high-dose chemotherapy with autologous bone marrow rescue, and new chemotherapeutic agents designed to penetrate the blood-brain barrier have not resulted in significant advances to date. However, there are exciting new directions in the chemotherapy of high-grade astrocytomas which are entering clinical trials. Two potentially promising approaches include interstitial chemotherapy using surgically implanted polymers and the continuous infusion of combinations of active chemotherapeutic agents. Other therapeutic modalities such as radioactive seed implants, stereotactic radiosurgery, and gene therapy are also being evaluated. Hopefully, this intense activity by subspecialists with a wide range of interests and expertise will produce novel and effective treatments for the large number of patients with malignant astrocytomas. In contrast, patients with many of the less common neoplasms of the central nervous system may benefit from the addition of chemotherapy to their treatment. Primary germ cell tumors or lymphomas of the central nervous system are very sensitive to chemotherapy. The germ cell tumors respond to the cisplatin-containing regimens developed for testicular malignancies. The optimal chemotherapy for CNS lymphoma is not clear but exciting results have been reported with a combination of radiation, systemic and intrathecal methotrexate, and systemic cytosine arabinoside. Although limited, the available literature suggests that patients with anaplastic oligodendrogliomas may also benefit from chemotherapy at diagnosis or at relapse. Studies in children suggest a benefit for adjuvant chemotherapy and radiation therapy in poor risk patients with medulloblastomas although these findings have not been confirmed in adults. Finally, anecdotal reports suggest that chemotherapy may be useful in the very rare patient who presents with a pineal tumor or an ependymoma.
患有原发性恶性脑肿瘤的成年患者是一个异质性群体。大多数患者会患有高级别星形细胞瘤，预计从当前的标准化化疗方案中获益甚微。动脉内化疗、自体骨髓挽救的大剂量化疗以及旨在穿透血脑屏障的新型化疗药物迄今尚未取得显著进展。然而，高级别星形细胞瘤化疗领域出现了令人兴奋的新方向，这些方向正进入临床试验阶段。两种潜在有前景的方法包括使用手术植入聚合物的间质化疗以及活性化疗药物组合的持续输注。其他治疗方式，如放射性粒子植入、立体定向放射外科和基因治疗也在评估之中。有望的是，众多具有广泛兴趣和专业知识的专科医生的这种积极活动，将为大量恶性星形细胞瘤患者带来新颖且有效的治疗方法。相比之下，患有许多中枢神经系统较罕见肿瘤的患者可能会从化疗加入其治疗方案中获益。原发性生殖细胞肿瘤或中枢神经系统淋巴瘤对化疗非常敏感。生殖细胞肿瘤对为睾丸恶性肿瘤开发的含顺铂方案有反应。中枢神经系统淋巴瘤的最佳化疗方案尚不清楚，但据报道，放疗、全身及鞘内甲氨蝶呤和全身阿糖胞苷联合使用取得了令人兴奋的结果。尽管有限，但现有文献表明，间变性少突胶质细胞瘤患者在诊断时或复发时也可能从化疗中获益。儿童研究表明，辅助化疗和放疗对髓母细胞瘤高危患者有益，尽管这些发现尚未在成人中得到证实。最后，轶事报道表明，化疗可能对极少数患有松果体肿瘤或室管膜瘤的患者有用。
