Chamberlain M C, Kormanik P A
University of California, Department of Neurosciences, San Diego, USA.
West J Med. 1998 Feb;168(2):114-20.
The treatment of patients with malignant gliomas is palliative and encompasses surgery, radiotherapy, and chemotherapy. Outcome measures have demonstrated improvement in both survival and neurologic performance in patients undergoing complete or near-complete tumor resection. After surgery, involved-field radiotherapy (radiotherapy administered to the tumor and to the tissue in a 3-cm radius surrounding the tumor) has been shown to further improve survival rates when given in a total dose of 6000-6500 cGy. Survival is further improved by the coadministration of the chemoradiopotentiator hydroxycarbamide (hydroxyurea). The role of adjuvant or boost stereotactic radiotherapy is unclear, despite its frequent use. In addition, adjuvant chemotherapy has been shown to improve survival rates in approximately one-quarter of patients with glioblastoma multiforme and in the majority of patients with anaplastic astrocytoma. No a priori method exists, however, to predict which patient will benefit from adjuvant chemotherapy. As a consequence, all physiological young patients with good performance status or limited neurologic disability are treated with chemotherapy. The best results of adjuvant chemotherapy are achieved with a nitrosourea chemotherapy, either carmustine (BCNU) or a combination of procarbazine and lomustine (CCNU) and vincristine, known as PCV-3 therapy. Salvage chemotherapy is reserved for patients with tumor progression, some of whom benefit from a re-operation. Occasional patients with recurrent gliomas may be palliated by stereotactic radiotherapy.
恶性胶质瘤患者的治疗是姑息性的，包括手术、放疗和化疗。结果指标显示，接受肿瘤完全或近乎完全切除的患者在生存率和神经功能方面均有改善。手术后，受累野放疗（对肿瘤及其周围3厘米半径范围内的组织进行放疗），当总剂量为6000 - 6500厘戈瑞时，已被证明可进一步提高生存率。同时给予化疗增敏剂羟基脲可进一步提高生存率。尽管辅助或增强立体定向放疗经常使用，但其作用尚不清楚。此外，辅助化疗已被证明可提高约四分之一的多形性胶质母细胞瘤患者和大多数间变性星形细胞瘤患者的生存率。然而，目前尚无先验方法来预测哪些患者将从辅助化疗中获益。因此，所有生理状态良好、功能状态良好或神经功能障碍有限的年轻患者都接受化疗。辅助化疗的最佳效果是通过亚硝基脲类化疗实现的，即卡莫司汀（BCNU）或丙卡巴肼、洛莫司汀（CCNU）和长春新碱的联合使用，即PCV - 3疗法。挽救性化疗适用于肿瘤进展的患者，其中一些患者可从再次手术中获益。少数复发性胶质瘤患者可通过立体定向放疗缓解症状。
