Neurotoxicity of combination chemotherapy with procarbazine, CCNU and vincristine (PCV) for recurrent glioma
Neurotoxicity of combination chemotherapy with procarbazine, CCNU and vincristine (PCV) for recurrent glioma
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DOI：
10.1023/a:1005909318270
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发表时间：
1998-05
影响因子：
3.9
通讯作者：
T. Postma;C. V. van Groeningen;R. Witjes;J. Weerts;J. Kralendonk;J. Heimans
中科院分区：
文献类型：
--
作者：
T. Postma;C. V. van Groeningen;R. Witjes;J. Weerts;J. Kralendonk;J. Heimans
在脑胶质瘤复发病例中，使用丙卡巴嗪、环己亚硝脲和长春新碱（PCV）联合化疗作为辅助治疗。标准PCV通常耐受性良好，但强化PCV（CCNU 130 mg/m2，第1天，丙卡巴肼75 mg/m2，第8-21天，长春新碱1.4 mg/m2，第8和29天;每6周6个疗程）耐受性较差。我们观察到中枢神经毒性副作用（局灶性神经功能缺损，认知障碍，EEG背景活动减慢，脑MR萎缩）与血液学和肝脏毒性相结合的26例PCV治疗复发性胶质瘤患者。长期骨髓抑制和/或持续（2例患者部分可逆）的神经功能缺损仍然影响日常生活中的三个月后停止化疗的4例患者。尽管所有四名患者都使用了抗惊厥药，并且过去曾接受过放射治疗，但我们强烈认为中枢神经毒性副作用与强化PCV治疗有关。我们提倡在复发性胶质瘤患者中使用标准PCV方案，因为这种潜在的毒性以及缺乏证据表明强化PCV比标准PCV在脑胶质瘤中更好地控制肿瘤。
In cerebral glioma combination chemotherapy with procabazine, CCNU and vincristine (PCV) is used as adjuvant therapy in cases of recurrence. Standard PCV is usually well tolerated, but intensive PCV (CCNU 130 mg/m2on day 1, procarbazine 75 mg/m2on day 8–21, vincristine 1.4 mg/m2on day 8 and 29; 6 courses every 6 weeks) is less well tolerated. We observed central neurotoxic side effects (focal neurological deficit, cognitive disturbances, slowing of EEG background activity, atrophy on cerebral MR) in combination with hematological and hepatic toxicity in four of 26 PCV treated patients with recurrent glioma. Prolonged myelosuppression and/or ongoing (partial reversible in two patients) neurological deficit still influence daily life in three of four patients months after discontinuation of chemotherapy. Despite the fact that all four patients used anticonvulsants and have been treated with radiotherapy in the past, we have the strong impression that central neurotoxic side effects are related to intensive PCV therapy. We advocate to use the standard PCV regimen in patients with recurrent glioma, because of this potential toxicity and the lack of evidence that intensive PCV leads to better tumor control than standard PCV in cerebral glioma.