Gundersen S, Lote K, Watne K
Department of Medical Oncology and Radiotherapy, Norwegian Radium Hospital, Montebello, Oslo, Norway.
Eur J Cancer. 1998 Sep;34(10):1565-9. doi: 10.1016/s0959-8049(98)00146-4.
The aim of this retrospective study was to evaluate the effect of adjuvant chemotherapy among patients < 55 years of age with anaplastic gliomas (historical grade 3, n = 85) with four cycles 4 weeks apart of 160 mg carmustine (BCNU) infused into the internal carotid artery, combined with vincristine 2 mg and procarbazine 50 mg x 3 for 1 week (i.a.BCNU-PV) versus no adjuvant chemotherapy. In glioblastomas (histological grade 4, n = 257) the same chemotherapy was evaluated versus two cycles 4 weeks apart of 160 mg lomustine (CCNU) orally instead of BCNU, combined with vincristine and procarbazine (PCV) versus no chemotherapy. All patients in both groups received radiotherapy. Among glioblastoma patients < 55 years of age there was a significant (P = 0.03), but moderately increased survival in the i.a.BCNU-PV group versus the two other arms that did not differ from each other. This difference could be explained by an uneven distribution of prognostic factors, especially age group (< 50 years versus 50-54 years) in favour of the i.a.BCNU-PV group. In anaplastic gliomas, the median survival in the i.a.BCNU-PV group was 80 months versus 25 months for the no chemotherapy arm (P = 0.004). No significant differences in the distribution of prognostic factors were found between the two therapy arms. We suggest that the role of adjuvant chemotherapy in glioblastomas is unclear, while i.a.BCNU-PV as adjuvant chemotherapy among patients < 55 years of age and with anaplastic gliomas increased survival markedly.
本回顾性研究的目的是评估辅助化疗对年龄小于55岁的间变性胶质瘤患者（既往3级，n = 85）的疗效。这些患者接受每4周1个周期、共4个周期的辅助化疗，将160 mg卡莫司汀（BCNU）经颈内动脉注入，同时联合2 mg长春新碱和50 mg丙卡巴肼×3、持续1周（即BCNU-PV方案），并与未接受辅助化疗的患者进行对比。在胶质母细胞瘤患者（组织学4级，n = 257）中，同样评估了上述化疗方案，但将BCNU换为每4周1个周期、共2个周期的160 mg洛莫司汀（CCNU）口服，同时联合长春新碱和丙卡巴肼（PCV方案），并与未接受化疗的患者进行对比。两组所有患者均接受了放疗。在年龄小于55岁的胶质母细胞瘤患者中，与另外两组彼此无差异的情况相比，即BCNU-PV组有显著（P = 0.03）但适度延长的生存期。这种差异可能是由于预后因素分布不均导致的，尤其是年龄组（< 50岁与50 - 54岁），BCNU-PV组更具优势。在间变性胶质瘤中，BCNU-PV组的中位生存期为80个月，而未化疗组为25个月（P = 0.004）。两个治疗组之间在预后因素分布上未发现显著差异。我们认为辅助化疗在胶质母细胞瘤中的作用尚不清楚，而对于年龄小于55岁的间变性胶质瘤患者，经颈内动脉注入BCNU联合PCV作为辅助化疗可显著提高生存期。
