Brown M T, Friedman H S, Oakes W J, Boyko O B, Hockenberger B, Schold S C
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Cancer. 1993 May 15;71(10):3165-72. doi: 10.1002/1097-0142(19930515)71:10<3165::aid-cncr2820711044>3.0.co;2-n.
Although pilocytic astrocytomas (PA) generally are considered benign, a subset of patients with PA have disease progression despite standard treatment with surgery and radiation therapy. The authors report their experience with chemotherapy in this patient group.
The authors treated 11 patients (4 males and 7 females; median age at diagnosis, 8 years) with pathologically confirmed PA with chemotherapy. In eight patients, tumor progression or recurrence despite prior surgery and radiation therapy led to chemotherapy treatment. In three children younger than 5 years, chemotherapy was given in lieu of radiation therapy immediately after diagnosis (in one patient) or at the time of disease progression after surgery (in two patients). The authors used ten different chemotherapy regimens to treat the 11 patients.
Chemotherapy produced clinical and radiographic improvement (R/R) in four (36%) patients, clinical stabilization and radiographic improvement (SD/R) in 1 (9%), clinical and radiographic stabilization (SD/SD) in 3 (27%), and was associated with clinical and radiographic progression (PD/PD) in 3 (27%). Three of the five patients with radiographic improvement had a greater than 75% reduction of maximal cross-sectional tumor area. Hematologic toxicity resulted in dose reductions in 43 of 110 (39%) total courses of chemotherapy. There were three hospitals admissions for fever and neutropenia and one chemotherapy-related death.
The authors conclude that chemotherapy may benefit those with progressive inoperable PA. Chemotherapy may delay the need for radiation therapy in young patients with unresectable PA requiring treatment. PA may be a chemosensitive primary brain tumor.
虽然毛细胞型星形细胞瘤（PA）通常被认为是良性的，但一部分PA患者尽管接受了手术和放射治疗的标准治疗，仍出现疾病进展。作者报告了他们在这一患者群体中使用化疗的经验。
作者对11例经病理证实为PA的患者（4例男性和7例女性；诊断时的中位年龄为8岁）进行了化疗。8例患者尽管先前接受了手术和放射治疗，但肿瘤进展或复发导致接受化疗。在3例5岁以下的儿童中，诊断后立即（1例患者）或手术后疾病进展时（2例患者）给予化疗以替代放射治疗。作者使用了10种不同的化疗方案来治疗这11例患者。
化疗使4例（36%）患者出现临床和影像学改善（R/R），1例（9%）患者临床稳定且影像学改善（SD/R），3例（27%）患者临床和影像学稳定（SD/SD），3例（27%）患者出现临床和影像学进展（PD/PD）。5例影像学改善的患者中有3例最大横截面肿瘤面积减少超过75%。血液学毒性导致110个化疗疗程中的43个（39%）疗程减少剂量。有3次因发热和中性粒细胞减少住院，1例与化疗相关的死亡。
作者得出结论，化疗可能使那些无法手术的进展性PA患者受益。化疗可能会延迟对需要治疗的不可切除PA的年轻患者进行放射治疗的需求。PA可能是一种对化疗敏感的原发性脑肿瘤。
