摘要
目的 评估卡铂联合依托泊苷(CE)方案治疗继发/复发高级别脑胶质瘤的有效性和安全性。方法 回顾性分析2018年10月至2021年1月在首都医科大学附属北京天坛医院神经肿瘤综合治疗病区治疗的5例继发和47例复发高级别胶质瘤患者的临床资料。所有患者接受CE方案治疗,其中14例患者因严重脑水肿接受CE+贝伐珠单抗治疗,10例患者因确诊软脑膜播散接受CE+甲氨蝶呤鞘注化疗。以全因死亡为随访终点。按照神经肿瘤反应评价(RANO)标准、不良事件通用术语5.0版(CTCAE5.0)标准评估治疗效果和不良反应。采用Kaplan-Meier分析无进展生存时间(PFS)和总生存时间(OS),采用Cox比例风险模型评估CE治疗方案对继发/复发高级别脑胶质瘤患者预后价值的影响。结果 所有患者初始诊断后的中位OS为27个月(范围为10~166个月),接受CE方案治疗后的中位OS为8个月(范围为1~26个月),中位PFS为6个月(范围为1~9个月),合并软脑膜播散患者的中位OS为9个月(范围为3~19个月)。在40例可用增强磁共振成像评估疗效的患者中,10例(25%)为部分缓解,24例(60%)为疾病稳定,6例(15%)为疾病进展,客观缓解10例,疾病控制34例。多因素Cox比例风险回归分析显示,既往辅助用药替莫唑胺≥6个周期(HR=2.157,95%CI=1.009~4.612)、CE化疗≥4个周期(HR=2.671,95%CI=1.189~6.003)是继发和复发高级别胶质瘤患者预后的影响因素(P<0.05)。患者的不良反应主要为1~2级,7例患者发生3~4级血液学毒性,1例患者出现3级胃肠道反应。结论 CE方案能够延长继发/复发高级别胶质瘤患者的生存期,合并软脑膜播散的患者在CE方案基础上联合鞘注化疗也观察到了获益的趋势。CE方案的总体安全性良好。
Objective To evaluate the efficacy and safety of carboplatin combined with etoposide(CE)in the treatment of secondary/recurrent high-grade glioma.Methods From October 2018 to January 2021,5 patients with secondary high-grade gliomas and 47 patients with recurrent high-grade gliomas treated with CE chemotherapy in the Department of Neuro-oncology,Cancer Center,Beijing Tiantan Hospital,Capital Medical University were collected.Among them,14 patients received CE and bevacizumab treatment for severe brain edema.10 patients who were diagnosed as leptomeningeal dissemination received CE and intrathecal methotrexate chemotherapy.Follow up endpoint was all cause death.Evaluate the efficacy according to Response Assessment in Neuro-oncology Criteria(RANO)standards and evaluate the adverse reactions with reference to Common Terminology Criteria for Adverse Events version 5.0(CTCAE 5.0).Kaplan-Meier curve was used to analyze progression-free survival(PFS)and overall survival(OS).Cox proportional risk model was used to evaluate the prognostic value of CE treatment in patients with secondary/recurrent high-grade gliomas.Results The median OS of all patients after initial diagnosis was 27 months(10-166 months);the median OS after CE treatment was 8 months(1-26 months);the median PFS was 6 months(1-9 months),and the median OS of patients with pia mater dissemination was 9 months(3-19 months).Among the 40 patients who could be evaluated for efficacy using enhanced magnetic resonance imaging,10(25%)had partial remission,24(60%)had stable disease,6(15%)had disease progression,10 had objective remission,and 34 had disease control.Multivariate Cox proportional hazard regression analysis showed that previous adjuvant temozolomide≥6 cycles(HR=2.157,95%CI=1.009-4.612)and CE chemotherapy≥4 cycles(HR=2.671,95%CI=1.189-6.003)were the prognostic factors of secondary and 47 patients with recurrent high-grade gliomas(P<0.05).The adverse reactions of patients were mainly grade 1-2.Seven patients had grade 3-4 hematology toxicity,and one p
作者
康勋
王亚丽
王策
康庄
陈峰
林艺
张波涛
杨守博
李文斌
Kang Xun;Wang Yali;Wang Ce;Kang Zhuang;Chen Feng;Lin Yi;Zhang Botao;Yang Shoubo;Li Wenbin(Department of Neuro-oncology,Cancer Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《神经疾病与精神卫生》
2023年第7期490-496,共7页
Journal of Neuroscience and Mental Health
