Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme.
Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme.
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DOI：
10.3171/2008.5.17557
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发表时间：
2009-03
影响因子：
4.1
通讯作者：
Quiñones-Hinojosa A
中科院分区：
文献类型：
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作者：
McGirt MJ;Than KD;Weingart JD;Chaichana KL;Attenello FJ;Olivi A;Laterra J;Kleinberg LR;Grossman SA;Brem H;Quiñones-Hinojosa A
Gliadel（BCNU）晶片和伴随的替莫唑胺（TMZ）治疗，当单独用作辅助治疗时，延长了多形性胶质母细胞瘤（GBM）的切除和放射治疗（XRT）所实现的生存期。Gliadel和TMZ联合治疗是否安全或进一步提高新诊断GBM患者的生存率仍有待研究。作者回顾了他们使用Gliadel、TMZ和放射疗法联合治疗GBM的初步经验。回顾性分析了10年（1997-2006年）期间接受GBM原发性切除伴或不伴Gliadel晶片（3.85%BCNU）植入和辅助XRT的所有病例。从2004年开始，伴随TMZ成为作者所在机构的标准治疗，所有Gliadel植入患者也接受伴随TMZ（Stupp方案）。评估了所有接受Gliadel加伴随TMZ治疗（XRT + Gliadel + TMZ）的患者的总生存期和治疗相关发病率。在XRT + Gliadel + TMZ（2003年后）和XRT + Gliadel（2004年前）队列之间进行了生存率和发病率的配对（≤ 70岁）比较。33例患者接受XRT + Gliadel + TMZ治疗。该组的中位生存期为20.7个月，2年生存率为36%。6个月的发病率包括1例（3%）手术部位感染、2例（6%）围手术期癫痫发作、1例（3%）深静脉血栓、3例（9%）肺栓塞和1例（3%）需要静脉注射地塞米松的脑水肿。骨髓抑制需要提前终止TMZ 7例（21%）（血小板减少症5例，中性粒细胞减少症2例）。在≤ 70岁的患者中，XRT + Gliadel + TMZ（30例患者，2003年后）与XRT + Gliadel（78例患者，2004年前）相比，与中位生存期（21.3 vs 12.4个月，p = 0.005）独立相关，2年生存率分别为39% vs 18%。在这些患者中，与XRT + Gliadel相比，XRT + Gliadel + TMZ与围手术期发病率增加无关。在该经验中，除了Gliadel晶片植入之外，伴随TMZ治疗与近21个月的中位生存期相关，而不会增加围手术期发病率。替莫唑胺可以安全地用于GBM切除后接受Gliadel晶片的患者。
Gliadel (BCNU) wafer and concomitant temozolomide (TMZ) therapy, when used individually as adjuvant therapies, extend survival from that achieved by resection and radiation therapy (XRT) for glioblastoma multiforme (GBM). It remains unstudied whether combining Gliadel and TMZ therapy is safe or further improves survival in patients with newly diagnosed GBM. The authors reviewed their initial experience utilizing combined Gliadel, TMZ, and radiation therapy for the treatment of GBM. All cases involving patients undergoing primary resection of GBM with or without Gliadel wafer (3.85% BCNU) implantation and adjuvant XRT over a 10-year period (1997–2006) were retrospectively reviewed. Beginning in 2004, concomitant TMZ became the standard of care at the authors’ institution and all patients with Gliadel implantation also received concomitant TMZ (Stupp protocol). Overall survival and treatment-related morbidity were assessed for all patients treated with Gliadel plus concomitant TMZ (XRT + Gliadel + TMZ). Age-matched (≤ 70 years) comparison of survival and morbidity was performed between the XRT + Gliadel + TMZ (post-2003) and XRT + Gliadel (pre-2004) cohorts. Thirty-three patients were treated with XRT + Gliadel + TMZ. The median survival in this group was 20.7 months, with a 2-year survival rate of 36%. Six-month morbidity included surgical site infection in 1 case (3%), perioperative seizures in 2 cases (6%), deep-vein thrombus in 1 (3%), pulmonary embolism in 3 (9%), and cerebral edema requiring admission for intravenous dexamethasone in 1 case (3%). Myelosuppression required premature termination of TMZ in 7 patients (21%) (thrombocytopenia in 5, neutropenia in 2 cases). In patients ≤ 70 years of age, XRT + Gliadel + TMZ (30 patients, post-2003) was independently associated with improved median survival (21.3 vs 12.4 months, p = 0.005) versus XRT + Gliadel (78 patients, pre-2004), with 2-year survival of 39 versus 18%, respectively. In these patients, XRT + Gliadel + TMZ was not associated with an increase in perioperative morbidity in comparison with XRT + Gliadel. In this experience, concomitant TMZ therapy in addition to Gliadel wafer implantation was associated with a median survival of nearly 21 months without increased perioperative morbidity. Temozolomide can be safely administered to patients receiving Gliadel wafers after resection of GBM.