Tailor-made chemotherapy against malignant gliomas based on chemosensitivity test and analysis of drug resistance gene

不同恶性胶质瘤的抗癌药物效果不同。这一机制可能与耐药基因的表达有关。采用化学敏感性试验考察体外抗癌药物的作用。采用胶原凝胶基质法进行化疗敏感性试验，为恶性胶质瘤患者量身定制化疗方案。采用RT-PCR法分析耐药基因mRNA表达情况。本文对53例恶性胶质瘤（间变性星形细胞瘤、胶质母细胞瘤）进行了研究。将手术获得的肿瘤组织培养8 d，用胶原凝胶基质法对6 ~ 9种抗癌药物进行了化疗敏感性试验。根据化疗敏感性，选择两种抗肿瘤药物经动脉内注射。提取总RNA， RT-PCR法检测耐药基因MDR、Topo II。将药敏试验结果与耐药基因表达进行比较。化疗敏感性试验肿瘤生长平均抑制率CBDCA组为42.7%，CDDP组为37.9%，ACNU组为30.8%，VCR组为3.2%。结果表明对铂类药物具有较高的敏感性。耐药基因表达与化疗敏感性无显著相关性（p=0.1）。此外，基于化疗敏感性试验的定制化疗患者的平均生存期与常规化疗患者的平均生存期差异无统计学意义（p=0.07）。尽管检查的病例很少，但应进一步研究量身定制的化疗方案。

Each malignant glioma shows different effect of anti-cancer drug. This mechanism could be related to expression of drug resistance gene. Effect of anti-cancer drug in vitro is examined with chemosensitivity test. Tailor made chemotherapy for malignant glioma was based on chemosensitivity test with collagen gel matrix method. In addition, mRNA expression of drug resistance gene was analyzed with RT-PCR method. Fifty-three cases of malignant gliomas (anaplastic astrocytoma, glioblastoma) were examined Tumor tissues obtained at surgery were cultured for 8 days for chemosensitivity test with collagen gel matrix method for 6 to 9 anti-cancer drugs. According to chemosensitivity, tow anti-cencer drugs were selected and injected through intra-arterial route. In addition, total RNA was extracted and RT-PCR method was performed for drug resistance genes such as MDR and Topo II. The result of chemosensitivity test was compared with expressions of drug resistance genes. Mean inhibition rate of tumor growth in chemosensitivity test showed 42.7% in CBDCA, 37.9% in CDDP, 30.8% in ACNU, and 3.2% in VCR. This result revealed high sensitivity in platinum drugs. Drug resistance gene expression was not significantly correlated with chemosensitivity (p=0.1). In addition, mean survival period of patients undergone with tailor made chemotherapy based on chemosensitivity test was not significantly different from mean survival period of patients undergone with conventional chemotherapy (p=0.07). In spite of small number of examined cases, tailor made chemotherapy should be further investigated.