Hösli P, Sappino A P, de Tribolet N, Dietrich P Y
Division of Medical Oncology, University Hospital, Geneva, Switzerland.
Ann Oncol. 1998 Jun;9(6):589-600. doi: 10.1023/a:1008267312782.
Despite more than two decades of clinical research with chemotherapy, the outcome of malignant gliomas remains poor. Recent years have seen major advances in elucidation of the biology of these tumors, which in turn have led to the current development of innovative therapeutic strategies. The question confronting us at the end of the 1990s is whether we should continue to use and investigate chemotherapy or whether the time has come for experimental treatments. As a contribution to this debate, we reviewed the abundant literature on chemotherapy of malignant glioma, paying special attention to methodological features. The new treatment approaches based on current knowledge about glioma biology are then briefly summarized. Assessment of more than 20 years of chemotherapy trials is discouraging despite a few areas of modest success. Only patients with specific histology (oligodendroglioma, anaplastic astrocytoma) and good prognostic factors (young age, good performance status) may benefit from chemotherapy, with a possible reversal of neurological dysfunction. However, the real impact on survival is small (anaplastic astrocytoma) or undefined (oligodendroglioma). Furthermore, it is unfortunately obvious that the outcome of glioblastoma patients is not significantly modified by chemotherapy. We believe the time has come to explore the potential of novel biological therapies in glioblastoma patients. This could also be proposed for anaplastic astrocytoma and oligodendroglioma patients after failure of chemotherapy.
尽管针对恶性胶质瘤进行了二十多年的临床化疗研究，但其治疗效果仍然不佳。近年来，在这些肿瘤生物学特性的阐明方面取得了重大进展，这反过来又推动了当前创新治疗策略的发展。在20世纪90年代末，我们面临的问题是，我们是应该继续使用和研究化疗，还是到了进行实验性治疗的时候了。作为对这场辩论的一份贡献，我们回顾了关于恶性胶质瘤化疗的大量文献，并特别关注其方法学特点。然后简要总结了基于当前对胶质瘤生物学认识的新治疗方法。尽管有一些小范围的成功领域，但对二十多年化疗试验的评估结果令人沮丧。只有具有特定组织学类型（少突胶质细胞瘤、间变性星形细胞瘤）且预后因素良好（年轻、身体状况良好）的患者可能从化疗中获益，神经功能障碍可能会有所逆转。然而，化疗对生存期的实际影响很小（间变性星形细胞瘤）或不明确（少突胶质细胞瘤）。此外，不幸的是，明显的是，化疗并未显著改善胶质母细胞瘤患者的治疗效果。我们认为，现在是时候探索新型生物疗法对胶质母细胞瘤患者的治疗潜力了。对于化疗失败后的间变性星形细胞瘤和少突胶质细胞瘤患者，也可以考虑采用这种疗法。
