顺铂联合替莫唑胺治疗MGMT启动子非甲基化的复发高级别胶质瘤

Treatment of recurrent high-grade gliomas with unmethylated MGMT promoter using cisplatin and temozolomide

目的探讨顺铂(DDP)联合替莫唑胺(TMZ)治疗MGMT启动子非甲基化的复发高级别胶质瘤的疗效.方法纳入2016年4月30日至2018年3月31日收治55例MGMT启动子非甲基化的复发高级别胶质瘤,均经过手术病理证实为高级别胶质瘤(WHOⅢ级或Ⅳ级)和MGMT启动子非甲基化.随访期间经头颅MRI和(或)再次手术的病理确诊为肿瘤复发,并给予DDP联合TMZ化疗.观察患者的不良反应和生存情况.结果WHOⅢ级有效率为12.0%(3/25),中位生存期为42个月;WHOⅣ级有效率为6.7%(2/30),中位生存期为17个月.总有效率为9.1%(5/55),总生存期为19个月.不良反应主要为骨髓抑制、胃肠道症状和肝肾功能损伤,经对症治疗后均恢复.结论DDP联合TMZ治疗MGMT启动子非甲基化的复发高级别胶质瘤具有一定的疗效.

Objectives To evaluate the safety and efficacy of cisplatin (DDP) and temozolomide (TMZ) in the treatment of recurrent high-grade gliomas with unmethylated MGMT promoter. Methods A total of 55 patients were included in this study. The patients were diagnosed with recurrent high-grade glioma with unmethylated MGMT promoter between 2016/04/30 and 2018/3/31. All patients in this group were confirmed by surgery and pathology as high-grade glioma (WHO class Ⅲ or Ⅳ) and unmethylated MGMT promoter. During the follow-up period, the recurrence was confirmed with the pathological diagnosis of reoperation and/or the head MRI. Treatment of DDP and TMZ was performed. The adverse events rates and survival conditions were observed to evaluate the results. Results The efficiency for WHOⅢ glioma patients was 12.0%(3/25). The median survival time was 42 months. In the meanwhile, the efficiency for WHO Ⅳ glioma patients was 6.7%(2/30) and the median survival time was 17 months. The mean overall survival rate of 55 patients was 19 months. The adverse events in this group mainly included different degrees of myelosuppression, gastrointestinal symptoms and liver and kidney function damage, which were all recovered after targeted treatment. Conclusions DDP and TMZ play an effective role in the treatment of recurrent high-grade gliomas with unmethylated MGMT promoter.