Soffietti R, Rudà R, Bradac G B, Schiffer D
Department of Neuroscience, University of Torino, Italy.
Neurosurgery. 1998 Nov;43(5):1066-73. doi: 10.1097/00006123-199811000-00035.
The role of chemotherapy in the treatment of low-grade oligodendrogliomas and oligoastrocytomas is still unclear. A Phase II study was conducted to determine the benefits and toxicity of the procarbazine, lomustine, and vincristine (PCV) regimen in patients with low-grade oligodendrogliomas and oligoastrocytomas recurrent after surgery alone or surgery with radiotherapy.
Patients with both enhancing and nonenhancing tumors were treated with up to six cycles of standard PCV, and response was evaluated by conventional criteria based on computed tomography or magnetic resonance imaging.
Sixteen of 26 patients (62%) responded to PCV: 3 (12%) experienced complete response, 13 (50%) experienced partial response, 8 (31%) had stable disease, and 2 (8%) had progressive disease. All symptomatic patients who responded and three with stable disease improved in seizure frequency, lateralizing signs, and symptoms of intracranial hypertension. The response rate for patients with enhancing lesions revealed by computed tomography or magnetic resonance imaging (74%) was significantly higher than that of patients with nonenhancing lesions (29%) (P < 0.05). Both oligodendrogliomas and oligoastrocytomas responded to PCV, with complete responses occurring in association with pure tumors only. The median time to tumor progression of all 26 patients was 24 months and was significantly longer for those with oligodendrogliomas compared with those with oligoastrocytomas (32 versus 12 mo) (P < 0.001). Chemotherapy was well tolerated, with mild hematological toxicity and rare skin rashes being the most frequent sequelae.
These results suggest that chemotherapy with PCV is effective in the treatment of recurrent low-grade oligodendrogliomas and oligoastrocytomas.
化疗在低级别少突胶质细胞瘤和少突星形细胞瘤治疗中的作用仍不明确。开展了一项II期研究，以确定丙卡巴肼、洛莫司汀和长春新碱（PCV）方案对单纯手术后复发或手术后放疗后复发的低级别少突胶质细胞瘤和少突星形细胞瘤患者的疗效及毒性。
对强化和非强化肿瘤患者均给予多达六个周期的标准PCV治疗，并根据计算机断层扫描或磁共振成像，采用传统标准评估疗效。
26例患者中有16例（62%）对PCV有反应：3例（12%）完全缓解，13例（50%）部分缓解，8例（31%）疾病稳定，2例（8%）疾病进展。所有有反应的有症状患者以及3例疾病稳定的患者癫痫发作频率、定位体征和颅内高压症状均有改善。计算机断层扫描或磁共振成像显示有强化病灶的患者的反应率（74%）显著高于无强化病灶的患者（29%）（P<0.05）。少突胶质细胞瘤和少突星形细胞瘤对PCV均有反应，仅纯肿瘤出现完全缓解。所有26例患者的肿瘤进展中位时间为24个月，少突胶质细胞瘤患者的肿瘤进展中位时间显著长于少突星形细胞瘤患者（32个月对12个月）（P<0.001）。化疗耐受性良好，最常见的后遗症是轻度血液学毒性和罕见的皮疹。
这些结果表明，PCV化疗对复发性低级别少突胶质细胞瘤和少突星形细胞瘤有效。
