Gajjar A, Heideman R L, Kovnar E H, Langston J A, Sanford R A, Douglass E C, Jenkins J J, Horowitz M E, Kun L E
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tenn 38101.
Pediatr Neurosurg. 1993 May-Jun;19(3):113-8; discussion 119-20. doi: 10.1159/000120714.
Thirteen patients with low grade astrocytomas were treated with alkylating agent or platinum-based chemotherapy regimens. Eleven of these patients received chemotherapy as their initial postoperative treatment modality, and 2 others as treatment for progressive disease postradiation therapy. Responses were objectively determined using CT or MRI. One patient had a complete response (CR), 6 had partial responses (PR), and 3 others had stable disease (SD) as their best response. Clinical responses paralleled those determined objectively. Chemotherapy was well tolerated with the exception of ototoxicity in 4 patients treated with cisplatin. Despite good initial responses, 5 of 6 patients who received no further treatment postchemotherapy (4 PR, 1 SD) developed progressive disease 5-13 months after completing chemotherapy. The remaining 4 patients with objective responses or stable disease (1 CR, 2 PR, 1 SD), all received further postchemotherapy treatment with radiation therapy or surgery, and have not demonstrated disease progression. Our experience suggests that alkylator or platinum-based chemotherapy can successfully delay the growth of these locally infiltrative neoplasms, and should be considered in their primary management. Despite the experience of others, further therapy appears necessary in patients with residual CT or MRI abnormalities postchemotherapy.
13例低级别星形细胞瘤患者接受了烷化剂或铂类化疗方案治疗。其中11例患者将化疗作为术后初始治疗方式，另外2例则作为放疗后疾病进展的治疗手段。使用CT或MRI客观判定疗效。1例患者完全缓解（CR），6例部分缓解（PR），另外3例最佳疗效为疾病稳定（SD）。临床反应与客观判定结果相符。化疗耐受性良好，除4例接受顺铂治疗的患者出现耳毒性外。尽管初始反应良好，但6例化疗后未接受进一步治疗的患者（4例PR，1例SD）中有5例在完成化疗后5 - 13个月出现疾病进展。其余4例有客观反应或疾病稳定的患者（1例CR，2例PR，1例SD）均接受了化疗后的进一步放疗或手术治疗，且未出现疾病进展。我们的经验表明，烷化剂或铂类化疗可成功延缓这些局部浸润性肿瘤的生长，在其初始治疗中应予以考虑。尽管有其他经验，但化疗后CT或MRI仍有异常的患者似乎需要进一步治疗。
