肿瘤电场治疗胶质母细胞瘤1例

患者女性,31岁.因"间歇性头痛头晕伴呕吐1个月余"2018年3月于中南大学湘雅二医院就诊.术前MRI示:左侧顶叶及侧脑室巨大占位性病变,考虑脑胶质瘤可能(图1A).于2018年4月行肿瘤部分切除术,术后病理示:(左顶枕叶占位)组织多块,共7 cm×7 cm×3 cm.镜下见:肿瘤细胞密度高,核异型有多形性.微血管增生...     

肿瘤治疗电场在脑胶质母细胞瘤治疗中的现状与前景

肿瘤治疗电场是一种新的治疗方法,其通过低强度、中等频率的交变电场干扰肿瘤细胞有丝分裂,从而抑制肿瘤细胞增殖。在治疗复发胶质母细胞瘤患者的临床试验中,肿瘤治疗电场治疗组受试者与经验化疗组受试者相比生存期数据无显著性差异。而在治疗新发胶质母细胞瘤患者的临床试验中,肿瘤治疗电场联合替莫唑胺组受试者与替莫唑胺组受试者相比,生存期显著延长。鉴于肿瘤治疗电场在这两项Ⅲ期临床试验中的优异表现,其被美国国立综合癌症网络（NCCN）指南纳入复发和新发胶质母细胞瘤患者的一线治疗,其产品现已在美国、日本、以色列、中国香港获批准上市。本文对肿瘤治疗电场在脑胶质母细胞瘤治疗中的现状与前景进行综述。      

肿瘤电场治疗同步放化疗方案治疗新诊断胶质母细胞瘤的安全性评估

目的 评价肿瘤电场治疗同步放化疗方案用于治疗新诊断胶质母细胞瘤患者的安全性。方法 回顾性分析南京医科大学第一附属医院神经外科自2022年2月至2022年11月收治的23例新诊断胶质母细胞瘤患者的临床资料。所有患者皆采取肿瘤电场治疗同步放化疗方案。按照常见不良事件通用术语5.0版标准(CTCAE 5.0)和肿瘤电场治疗相关皮肤不良反应(dAE)分级标准记录不良事件。治疗依从性通过Optume Nove TTF-200A治疗设备的使用数据进行评估,以每日肿瘤电场治疗使用时间的百分比计算。结果 23例新诊断胶质母细胞瘤患者每日治疗中位时长为20.0 h,治疗依从性中位值为83.3%,dAE发生率为60.8%,主要为1级(56.5%)和2级(4.3%),无3～4级dAE。dAE主要表现为接触性皮炎、水泡、皮损等。21.7%(5/23)患者出现1～2级放化疗相关血液学不良反应,未发生严重血液系统疾病和重度电解质紊乱。结论 新诊断胶质母细胞瘤术后采取肿瘤电场治疗同步放化疗方案是安全可靠的。     

肿瘤电场治疗联合多柔比星及放化疗治疗复发胶质母细胞瘤1例报道

<正>0引言Li-Fraumeni综合征是一种罕见的常染色体显性遗传肿瘤综合征,以多种肿瘤发病高风险为特征。多形性胶质母细胞瘤（glioblastoma multiforme,GBM）来源于中枢神经系统神经上皮细胞,是最常见、最具侵袭性的颅内原发恶性肿瘤,具有术后高复发率、高死亡率、低治愈率等特点,目前针对胶质母细胞瘤的治疗方法主要为手术结合术后放疗和化疗,尽管有肿瘤电场治疗、免疫治疗等新方案,     

肿瘤电场治疗联合药物治疗老年复发性胶质母细胞瘤1例

患者女性,68岁.间断头痛1个月加重1周起病, 2018年8月外院头颅MRI示:右侧枕叶肿瘤性病变,考虑胶质瘤的可能性大(图1A).并于外院行颅内肿物切除术,术后病理示:胶质母细胞瘤(WHO Ⅳ级).2018年9月于天津市环湖医院行Stupp方案,即替莫唑胺75 mg/(m2·d)同步放化疗.放疗前MRI见图1B.放疗...     

复发胶质母细胞瘤的再手术治疗

目的 探讨复发胶质母细胞瘤患者中再手术对生存时间的延长及生存质量改善的影响.方法 对20例复发胶质母细胞瘤患者在手术前的功能状态、2次手术间隔时间与术后生存期等资料进行回顾性分析.结果 再手术患者术后中位生存期约8个月.再手术前KPS评分≥70分者中位生存期约10个月,<70分者中位生存期约5个月(P<0.01).2次手术间隔时间超过12个月者中位生存期约12个月,间隔时间不足12个月者中位生存期约6个月(P<0.05).结论 尽管并非所有复发胶质母细胞瘤患者均需行再手术,但对于术前功能情况良好、手术间隔时间超过12个月者,再手术治疗可获得较好的疗效.     

《中国肿瘤临床》文章推荐:肿瘤治疗电场在脑胶质母细胞瘤治疗中的现状与前景

肿瘤治疗电场是一种新的治疗方法,其通过低强度、中等频率的交变电场干扰肿瘤细胞有丝分裂,从而抑制肿瘤细胞增殖。在治疗复发胶质母细胞瘤患者的临床试验中,肿瘤治疗电场治疗组受试者与经验化疗组受试者相比生存期数据无显著性差异。而在治疗新发胶质母细胞瘤患者的临床试验中,肿瘤治疗电场联合替莫唑胺组受试者与替莫唑胺组受试者相比,生存期显著延长。鉴于肿瘤治疗电场在这两项Ⅲ期临床试验中的优异表现,其被美国国立综合癌症网络指南纳入复发和新发胶质母细胞瘤患者的一线治疗,其产品现已在美国、日本、以色列、中国香港获批准上市。为进一步了解肿瘤治疗电场在脑胶质母细胞瘤治疗中的现状与前景,2019年第24期《中国肿瘤临床》特邀首都医科大学附属北京天坛医院神经外科李文斌教授撰写《肿瘤治疗电场在脑胶质母细胞瘤治疗中的现状与前景》一文,为胶质母细胞瘤患者的一线治疗提供参考。     

肿瘤电场治疗联合同步放疗治疗胶质母细胞瘤研究进展

对于新诊断胶质母细胞瘤患者, 放射治疗后使用肿瘤电场治疗联合替莫唑胺, 是目前的标准方案之一。近来, 肿瘤电场治疗由于其能够延迟DNA修复和增加DNA复制压力的特性, 被越来越多地应用于同步放射治疗, 并在一些临床研究中显示出了一定疗效, 但关于其理论基础、对放疗剂量的影响、实际临床操作、患者获益、安全性等一直存在争议, 缺乏一致性的共识。本文就上述内容的研究进展进行了回顾。     

脑胶质母细胞瘤术后辅助治疗的研究进展

恶性胶质瘤（MG）是颅内常见的原发性肿瘤。其中,多形胶质母细胞瘤（GBM）是恶性程度最高的肿瘤,GBM呈浸润性生长,单纯手术往往难以彻底根除,术后复发率很高,中位生存期（MST）多为9—15个月。近年来GBM的临床治疗取得了一些进展,许多学者越来越重视手术后的其他治疗方法,包括放疗、化疗、分子靶向治疗等。     

1例胶质母细胞瘤患者获益于去骨瓣术后维持电场治疗

<正>患者女性,60岁,因意识障碍、左下肢无力于2020年6月于暨南大学第二临床医学院影像科行MRI显示右侧额颞叶病变伴中线偏移（图1A,1B,1D,1E）,考虑为脑恶性肿瘤合并大脑镰下疝。为降低术后恶性颅内压风险,行右额颞叶占位次全切除+去骨瓣减压术。术后病理显示：右颞叶胶质母细胞瘤（glioblastoma,GBM）(WHO 4级,IDH野生型),见图1C,1F。基因检测：IDH野生型,1p/19q未缺失,MGMT启动子甲基化（+）。术后20天查体：患者发音不清;KPS评分<60分,手术切口愈合良好,左侧肢体肌力为Ⅲ级。于2020年7月开始接受同期放化疗（concurrent chemoradiotherapy,CCRT）联合3个周期贝伐珠单抗治疗。CCRT治疗结束1个月后,开始替莫唑胺序贯6个周期辅助化疗。     

A pilot study of metronomic temozolomide treatment in patients with recurrent temozolomide-refractory glioblastoma

Frequent regular administration of chemotherapeutic agents at low doses, known as 'metronomic chemotherapy', can increase the anti-angiogenic activity of the drugs, as has been confirmed by several other experimental tumor models. The aim of this pilot study was to evaluate the efficacy and safety of metronomic temozolomide (TMZ) treatment in twelve consecutive patients with recurrent TMZ-refractory glioblastoma. The patients were administered by metronomic treatment schedule (continuous low-dose chemotherapy) with TMZ at a daily dose of 40 mg/m(2). The median overall survival (OS) and progression-free survival (PFS) from the start of metronomic treatment were 11.0 months (95% CI, 5.2-10.5 months) and 6.0 months (95% CI, 0-12.3 months), respectively. During the follow-up period, complete response (CR) was not achieved in any patient, partial response (PR) in 2, and stable disease (SD) in 5 patients. Estimated PFS (CR+PR+SD) was 58.3% at 3 months. Grade III/IV toxicity according to the National Cancer Institute Common Toxicity Criteria (NCI CTC) was not found. These results suggest that the change of chemotherapeutic schedule from conventional to metronomic treatment overcomes the chemo-resistance in patients with recurrent TMZ-refractory glio-blastoma without any major toxicity.     

A pilot clinical study of Delta9-tetrahydrocannabinol in patients with recurrent glioblastoma multiforme

Delta(9)-Tetrahydrocannabinol (THC) and other cannabinoids inhibit tumour growth and angiogenesis in animal models, so their potential application as antitumoral drugs has been suggested. However, the antitumoral effect of cannabinoids has never been tested in humans. Here we report the first clinical study aimed at assessing cannabinoid antitumoral action, specifically a pilot phase I trial in which nine patients with recurrent glioblastoma multiforme were administered THC intratumoraly. The patients had previously failed standard therapy (surgery and radiotherapy) and had clear evidence of tumour progression. The primary end point of the study was to determine the safety of intracranial THC administration. We also evaluated THC action on the length of survival and various tumour-cell parameters. A dose escalation regimen for THC administration was assessed. Cannabinoid delivery was safe and could be achieved without overt psychoactive effects. Median survival of the cohort from the beginning of cannabinoid administration was 24 weeks (95% confidence interval: 15-33). Delta(9)-Tetrahydrocannabinol inhibited tumour-cell proliferation in vitro and decreased tumour-cell Ki67 immunostaining when administered to two patients. The fair safety profile of THC, together with its possible antiproliferative action on tumour cells reported here and in other studies, may set the basis for future trials aimed at evaluating the potential antitumoral activity of cannabinoids.     

Efficacy and safety of anlotinib in patients with advanced malignancy: a single-center,single-arm,phase 2 trial

Background

For advanced tumors that lack specific oncogenic alteration and are resistant to chemotherapy, anti-angiogenesis therapy or immunotherapy or a combination of the two are the most important treatments. Anlotinib is a newly developed oral small molecule receptor tyrosine kinases inhibitor with the potency of inhibiting tumor angiogenesis. This was an open-label, single-arm, phase 2 study to validate the efficacy and safety of anlotinib in patients with various cancer types.

Methods

Patients with advanced malignancy who have failed previous therapies or lack effective treatment choices received daily oral administration of 12 mg anlotinib on days 1–14 every 3 weeks until disease progression, intolerable toxicity or physician decision. The primary endpoint was objective response rate (ORR).

Results

A total of 93 eligible patients with 26 different cancer types were enrolled. The overall ORR was 21.5%. The median PFS was 5.7 months and median OS was 12.0 months. The most common treatment-related AE of all grades and of grade 3 was both hypertriglyceridemia at an incidence of 40.9% and 5.4%, respectively.

Conclusions

Anlotinib exhibits objective efficacy and safety in advanced malignancy and might be a possible treatment option for many types of cancer patients who have failed prior treatment and with no optimal therapy regimen.

     

Fast neutrons compared with megavoltage x-rays in the treatment of patients with supratentorial glioblastoma: a controlled pilot study

The radioresistance of glioblastoma presumably results from the presence of hypoxic cells. In an attempt to overcome this problem, fast neutrons were compared in a controlled pilot study with conventional megavoltage X-rays (photons). 63 patients entered the study between January, 1973 and July, 1976, 30 patients received neutron and 33 received X-ray therapy. The overall mean survival was 11.4 months for those who received photon and 10 months for those who received neutron therapy. Survival rates at 6 and 12 months were 72 % and 36 % respectively for photon treated patients, and 77 % and 30 % for those treated with neutrons. Although neutron therapy did not improve overall survival, examination of the histological material indicated a considerably greater antitumor effect after neutron therapy than after treatment with photons. In the neutron treated group, at post-mortem examination no tumor or only minimal tumor was found in 10 of 12 patients and in one of 4 patients where tissue was obtained from a second craniotomy. In some cases, there was evidence of diffuse damage to normal brain which was in keeping with a clinical syndrome of progressive dementia without localizing signs. Dose, time, and volume factors for neutron therapy to the brain and possible ways of improving results are discussed.     

Long-term survival in patients with recurrent glioblastoma treated with bevacizumab: a multicentric retrospective study

Journal of Neuro-Oncology - Recurrence of glioblastoma (GB) occurs in most patients after standard concomitant temozolomide-based radiochemotherapy (CTRC). Bevacizumab (BV), an anti-VEGF antibody,...     

Same-day discharge after brain tumor resection: a prospective pilot study

Journal of Neuro-Oncology - Outpatient brain surgery has many advantages for the psychological and physical wellbeing of patients, as well as reduced costs to the health care system. Compared with...     

A pilot study of everolimus and gefitinib in the treatment of recurrent glioblastoma (GBM)

Twenty-two patients with recurrent glioblastoma (GBM) were prospectively treated with everolimus and gefitinib, designed to test the combined inhibition of mammalian target of rapamycin (mTOR) and epidermal growth factor receptor (EGFR) as part of a larger clinical trial. The primary endpoint was radiographic response rate. Secondary endpoints included progression-free survival and correlation of molecular profiles with treatment response. 36% of patients had stable disease and 14% a partial response; however, responses were not durable and only one patient was progression-free at six months. Radiographic changes were not well characterized by conventional response criteria, and implied differential effects of therapy within the tumor and/or antiangiogenic effects. EGFR and PTEN status did not clearly predict response to treatment.