Protective effect on normal brain tissue during a combinational therapy of 2-deoxy-d-glucose and hypofractionated irradiation in malignant gliomas.
Protective effect on normal brain tissue during a combinational therapy of 2-deoxy-d-glucose and hypofractionated irradiation in malignant gliomas.
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DOI：
10.4103/1793-5482.110274
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Vani S
中科院分区：
文献类型：
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作者：
Venkataramanaa NK;Venkatesh PK;Dwarakanath BS;Vani S
目的探讨糖代谢抑制剂2-脱氧-D-葡萄糖（2-DG）在大分割放射治疗中对胶质母细胞瘤及正常脑组织的影响。20例恶性胶质瘤患者（18例多形性胶质母细胞瘤，2例发育不良星形细胞瘤III级）手术后每周（一次）用2-DG（250 mg/kg体重）治疗，随后每次对肿瘤床进行5戈伊放疗，持续7周。在每个周期进行临床评估、完整的血象和随机血糖水平。进行随访计算机断层扫描（CT）/磁共振成像（MRI）以评价辐射诱导的变化。记录术前、术后、治疗后至末次随访时Kernofsky评分（KPS）。本试验招募了20例患者;其中19例完成治疗，1例中止治疗。治疗后的生存期为6至36个月，中位生存期为14个月。CT和MRI显示明显的肿瘤坏死。再探查时组织的组织学证据证实了2-DG对正常脑具有保护作用的假设。术后6个月KPS评分大多在80%以上。放射治疗联合2-DG可选择性地显著促进肿瘤坏死，而正常脑组织得到相对保护。这已经反映在我们的研究中，无论是临床上的生活质量的保护和病理学上的保留正常的大脑结构的完整性。
To investigate the effect of 2-deoxy–D-glucose (2-DG), an inhibitor of glucose transport and glycolysis, on glioblastoma and the normal brain tissue during combined treatment with hypofractionated radiotherapy. Twenty patients with malignant gliomas (18 Glioblastoma Multiformae, 2 Anasplastic Astrocytoma grade III) following surgery were treated weekly (once) with 2-DG, (250 mg/kg body weight), followed by 5 Gy of radiation to the tumor bed per fraction for 7 weeks. Clinical evaluation, complete hemogram, and random blood sugar levels were carried out in each cycle. Follow-up computed tomography (CT)/magnetic resonance imaging (MRI) was done to evaluate radiation-induced changes. Kernofsky Performance scale (KPS) was recorded preoperatively; postoperatively, and post-therapy till the last follow-up. Twenty patients were recruited for this trail; 19 of them completed the treatment and 1 discontinued. The survival period ranged between 6 and 36 months after the treatment, with a median survival of 14 months. CT and MRI revealed significant tumor necrosis. Histological evidence from the tissue during reexploration confirms the hypothesis of protective effect of 2-DG on normal brain. KPS was above 80% in majority of the patients, 6 months after the surgery. Radiotherapy coupled with 2-DG enhances tumor necrosis selectively and significantly while the normal brain gets relatively protected. This has been reflected in our study both clinically by preservation of quality-of-life and pathologically by retaining the integrity of normal brain architecture.