胶质瘤的优化治疗..ppt

* * 结 果 * * B+IRI +RT TMZ + RT P 中位OS 16.6 17.5 无差异 PFS-6m 79.3% 42.6% ﹤0.0001 3或4级的血管紊乱 10.9% 3.6% 血液毒性 1.7% 14.8 % 结 论 BEV/IRI治疗新诊断MGMT非甲基化GBM患者 6个月PFS得到显著提高。 OS 无差异。可能是TMZ组二线交叉到BEV治疗的患者比例较高（有81.8% 完成二线交叉BEV治疗)。 平均每日使用的类固醇少于TMZ组， 但3级或4级腹泻及恶心、伤口感染和蛋白尿发生率也高于TMZ组。 * * Herringer U, et al. 2013 ASCO Abstract LBA2000. *药物由资助方支持 关于MGMT非甲基化GMB的思考 虽然MGMT非甲基化GMB对TMZ 不敏感，但是化疗 似乎也无更好的选择。 对于老年或PS差的患者，单独使用低分割放疗或标准放疗也是合理的。 个体化的提高放疗剂量（联合化疗）可能会获益。 * * 小 结 老年患者：可耐受标准治疗者更获益。不能耐受联合治疗者，MGMT 启动子甲基化人群，TMZ 较单独放疗更获益。 辅助治疗启动时机：化疗早使用，放疗在术后第5周左右。 延长使用：治疗有效者更获益。（MGMT甲基化者） MGMT未甲基化者：个体化增加放疗剂量联合TMZ；可考虑BEV/IRI。 * * 肿瘤 患者 Expected survival of glioma * * 1p19q * * * * 过 犹 不及 * Most patients with glioblastoma are older than 60 years, but treatment guidelines are based on trials in patients aged only up to 70 years. We did a randomised trial to assess the optimum palliative treatment in patients aged 60 years and older with glioblastoma. * Standard radiotherapy was associated with poor outcomes, especially in patients older than 70 years. Both temozolomide and hypofractionated radiotherapy should be considered as standard treatment options in elderly patients with glioblastoma. ? MGMT?promoter methylation status might be a useful predictive marker for benefit from temozolomide. * 结论支持老年患者单独使用低分割放疗或单独使用TMZ 作为 * * Abstract The efficacy of temozolomide (TMZ) plus radiation therapy (RT) in elderly patients with glioblastoma is unclear. We performed a large multicenter retrospective study to analyze prognostic factors and clinical outcome in these patients. Inclusion criteria were age ≥65 years, newly histologically confirmed glioblastoma, ECOG PS 0-2, adjuvant treatment with RT plus TMZ. We enrolled 237 patients; the average age was 71 and ECOG PS was 0-1 in 196 patients; gross total resection was performed in 174 cases. MGMT was analyzed in 151 persons and was methylated in 56 %. IDH1 was assessed in 100 patients and was mutated in 6 %. Seventy-one patients were treated with RT 40 Gy and 166