三尖杉酯碱和BCNU脑血管内化疗治疗恶性脑瘤的疗效比较

本研究的目的在于比较三尖杉酯碱和ＢＣＮＵ超选择性脑血管内灌注治疗恶性脑瘤的疗效。结果表明，三尖杉酯碱和ＢＣＮＵ对脑瘤的总有效率分别为７６．９％和７５％，化疗后肿瘤体积缩小率分别为３８．４６％和４０．０１％。各组治疗前后肿瘤体积变化均有显著差异，两组疗效对比无明显差异．然而，与ＢＣＮＵ组相比，三尖杉酯碱组脑瘤总的恶性程度较高，并发症少而轻且平均生存时间较长。作者认为三尖杉酯碱对恶性脑瘤的疗效优于ＢＣＮＵ，且前者价廉易得，值得推广应用．     

恶性脑胶质瘤动脉内灌注化疗

脑胶质瘤的治疗是神经外科的难题之一。近年来,大量动物实验和临床试验证明,动脉内化疗能延长恶性胶质瘤病人的存活时间,减轻化疗药物毒性作用。本文对近十年来恶性脑胶质瘤动脉内灌注化疗的有关进展作一综述。     

脑恶性肿瘤超选择性动脉内化疗

脑恶性肿瘤虽经手术切除、放疗及静脉内化疗,其平均生存期仍然不超过16个月。经静脉全身化疗,由于全身性毒副作用较大,受到剂量限制影响其疗效,而颈内动脉灌注化疗,可将药物有效浓度灌注到颅内肿瘤组织,减轻全身毒性反应,延长化疗药在肿瘤内的滞留时间,有效发挥化疗药对肿瘤细胞的杀伤作用。不足的是导管插在眼动脉开口以下时,化疗后常出现严重的眼及眶部并发症。近年来,随着神经介入的迅速发展,采用超选择性动脉内化疗可弥补上述不足,有效地发挥化疗药的作用。     

脑恶性肿瘤超选择性动脉内化疗

脑恶性肿瘤虽经手术切除、放疗及静脉内化疗，其平均生存期仍然不超过16个月。经静脉全身化疗，由于受到剂量限制，全身性毒副反应较大，影响其疗效。而颈内动脉灌注化疗，可将药物有效浓度灌注到颅内肿瘤组织，减轻全身毒性反应，延长化疗药在肿瘤内的滞留时间，     

动脉内注入BCNU治疗恶性胶质瘤的初步报告

1986年6月至1987年6月,我们对手术后及术后复发的8例胶质母细胞瘤病人,经颈内动脉插管注入 BCNU 进行治疗。经临床和 CT 观察,效果满意,现报告如下。临床资料和方法一、病人:本组8例,男性6例,女性2例,年龄29～60岁,平均50.2岁。8例中原发肿瘤2例,复发肿瘤6例。8例中实体肿瘤6例,瘤内有囊性变的2例。本组均在     

脑恶性胶质瘤瘤内化疗现状

综述了近年来瘤内化疗治疗脑恶性胶质瘤应用现状,通过多种给药方式,将大剂量化疗药物注入瘤内以提高瘤内化疗药物浓度,杀死肿瘤细胞,改善脑恶性胶质瘤疗效。     

罂粟碱开放血脑屏障动脉化疗96例恶性胶质瘤长期效果

目的观察和分析罂粟碱可逆性开放血脑屏障动脉注药化疗恶性胶质瘤的效果。方法对96例恶性胶质瘤病人经颈动脉穿刺注入罂粟碱可逆性开放血脑屏障后,动脉注入卡莫司汀(BCNU)进行治疗,连续观察20~23年。结果 96例中5年生存率25%,10年生存率11.45%,20年生存率10.4%。目前仍有10例生存,最长23年多。结论罂粟碱可逆性开放血脑屏障动脉注药化疗恶性胶质瘤可作为术后化疗的一种方式。     

动脉化疗后恶性胶质瘤病人长期生存的分析

对 198 8年 9月至 1992年 9月经动脉化疗的 96例恶性胶质瘤病人进行连续 10～ 14年的观察。临床资料　　本组男 5 8例 ,女 38例。年龄 12～ 72岁 ,平均 4 3 72岁。经手术后病理证实胶质母细胞瘤 5 4例 ,间变性星形细胞瘤 4 2例。肿瘤在肉眼下全切除 5 7例 ,次全切除 6例 ,大部分切除 31例 ,部分切除 2例。全部病人均经颈动脉穿刺注入罂粟碱可逆性开放血脑屏障后 ,动脉注入ＢＣＮＵ进行治疗[1] ,共注药 2 16次 ,每例 1～ 9次不等 ,平均2 2 5次。结　　果　　随访 :96例病人均得到随访 ,96例中平均生存期 4 1 38(3972 / 96 )个月 ,5年生存率 …     

脑恶性胶质瘤瘤内化疗现状

目前对于脑恶性胶质瘤仍为手术、放疗、化疗及免疫等综合治疗,但预后仍不甚满意,平均生存期在6～8个月。化疗有助于改善脑恶性胶质瘤的治疗效果。因此,国内外学者都力图寻找多种给药方法治疗脑恶性胶质瘤。瘤内化疗可避开血脑屏障、降低全身血药浓度和减少化疗引起的副作用,能获得化疗药在脑内更长时间的作用效果。     

脑恶性肿瘤超选择性动脉内化疗

脑恶性肿瘤虽经手术切除、放疗及静脉内化疗,其平均生存期仍然不超过16个月,经静脉全身化疗,由于受到剂量限制,全身性毒副反应较大,影响其疗效。而颈内动脉灌注化疗,可将药物有效浓度灌注到颅内肿瘤组织,减轻全身毒性反应,延长化疗药在肿瘤内的滞留时间,有效发挥化疗药对肿瘤细胞的杀伤作用。不足的是导管插在眼动脉开口以下时,化疗后常出现严重的眼及眶部并发症。近年来,随着神经介入的迅速发展,采用超选择性动脉内化疗可弥补上述不足,有效地发挥化疗药的作用。     

恶性脑肿瘤的超选择性脑动脉灌注治疗

目的:对恶性脑胶质细胞瘤术后残留的肿瘤组织,用化疗方法将其杀灭和抑制生长,以延长病人的生存期和改善生存质量;并比较嘧啶亚硝脲(ACNU)加氨甲喋呤(MTX)(A组)以及三尖杉酯碱加MTX(B组)的疗效。方法:将ACNU2～3mg/kg,三尖杉酯碱0.1～0.5mg/kg,MTX0.1～0.2mg/kg按A、B两组方案,采用超选择性脑动脉内联合灌注化疗,每例1～5次不等。结果:A组12例中CR1例,PR3例,NC7例,PD1例;B组12例中CR1例,PR2例,NC7例,PD2例。A组和B组对恶性脑胶质瘤的有效率分别为33.33％和25％,化疗后肿瘤体积缩小率分别为48.32％和46.21％,各组治疗前后肿瘤体积变化均有显著性差异,但两组疗效对比无明显差异。结论:恶性脑胶质细胞瘤术后辅以超选择性脑血管内化疗,能抑制肿瘤生长,ACNU加MTX与三尖杉酯碱加MTX的联合化疗方案合理,毒副作用小。     

联合化疗治疗颅内恶性肿瘤临床应用

目的应用联合化疗治疗颅内恶性肿瘤,使其部分或全部消失,以延长病人的生存期提高病人的生存质量。方法将宁得朗（ＡＣＮ－Ｕ）２～３ｍｇ／ｋｇ溶解后静脉输入,每１０－１４天１次,长春新碱（ＶＣＲ）２ｍｇ溶解后静脉输入,每７天１次,氨甲蝶呤（ＭＴＸ）１０ｍｇ地塞米松５ｍｇ通过腰穿技术缓慢注入蛛网膜下腔。结果　通过一个疗程的治疗,１６例病人中完全消失（ＣＲ）３例,部分消失（ＰＲ）８例,无变化（ＮＣ）４例,肿瘤增大（ＰＤ）１例,２例胶母术后存活３年,平均随访１年,总缓解率６９％。结论　联合化疗对治疗颅内恶性肿瘤有比较明显的效果。     

脑肿瘤超选择性脑动脉灌注化疗的临床分析

目的:研究超选择性脑动脉插管灌注嘧啶亚硝脲(ACNU)或卡氮芥(BCNU)治疗恶性脑肿瘤的近期疗效及其并发症的防治。方法:对67例经组织学确诊的恶性脑肿瘤采用超选择性脑动脉插管灌注嘧啶亚硝脲或卡氮芥化疗,并对照化疗前后的影像学表现,评价该化疗对恶性脑肿瘤的疗效。结果:本组67例病人治疗后完全缓解10例(14.9％),部分缓解43例(64.2％),稳定11例(16.4％),恶化3例(4.5％)。对部分病例行免疫组化和神经病理研究,证实超选择性脑动脉灌注化疗可诱导肿瘤的凋亡。超选择性脑动脉插管灌注化疗可明显降低常规化疗的并发症和毒性反应,并发症和毒性反应的发生率明显低于文献报道。结论:超选择性脑动脉插管灌注化疗治疗恶性脑肿瘤可明显降低药物毒性,近期疗效良好。     

脑胶质瘤替尼泊甙动脉超选择灌注及司莫司汀口服化疗

目的观察脑胶质瘤替尼泊甙动脉（VM_(26)）及口服司莫司汀（MeCCNU）化疗的疗效。方法对68例肿瘤切除手术后的脑胶质瘤病人行VM_(26)动脉超选择灌注及MeCCNU口服化疗,每间隔6－8周为一疗程,首次化疗后6个月将计算机体层摄影（CT）或磁共振成像（MRI）显示的肿瘤体积变化及临床症状评价与化疗前相比较。结果本组68例病人治疗后完全缓解9例（13．2％）,部分缓解27例（39．8％）,稳定19例（27．9％）,恶化11例（16．2％,早期死亡（2．9％）。本组病例1年存活率89．7％,2年72．1％,3年以上存活率22．1％。全部病人无严重并发症及毒性反应。结论对手术切除的胶质瘤病人采用MeCCNU联合化疗,有益于提高胶质瘤病人的生存质量。     

脑干肿瘤的手术治疗

手术治疗6例脑干肿瘤病人,次全切除2例,大部切除1例,部分切除3例.术后临床表现明显改善1例,改善3例.无变化2例,无一例术后死亡.作者认为脑干肿瘤手术治疗成功的关键在于手术适应证的选择.弥漫性脑于肿瘤不适合手术治疗,局限性脑于肿瘤、囊性脑干肿瘤、颈髓延髓交界处脑于肿瘤及背侧外生性脑干肿瘤适合手术治疗.其中囊性脑干肿瘤、颈髓延髓交界处脑于肿瘤、背侧外生性脑干肿瘤常能做到肿瘤的全切除或次全切除.     

Preirradiation chemotherapy for very young children with brain tumors

Standard management of malignant brain tumors includes either surgical resection alone or surgery followed by irradiation. However, neuroaxis irradiation administered to very young children for primary intracranial tumors is often associated with major late side effects. To delay irradiation and evaluate the efficacy of preirradiation chemotherapy, we treated 9 young children (aged less than 3 years), who had newly diagnosed brain tumors and underwent total or subtotal resection, with a combination of chemotherapy including vinblastine, cisplatin, and etoposide every 3–4 weeks for 6–14 courses between 1988 and 1992. There were malignat gliomas in four patients, medulloblastomas in three, and ependymomas in two. A response to preirradiation chemotherapy (complete remission or partial remission) occurred in seven out of nine cases. Only one patient had progressive disease during the chemotherapy period. Preirradiation chemotherapy with vinblastine, cisplatin, and etoposide might be a highly effective combination allowing delay of radiation therapy in very young children with brain tumors. Acute and subacute toxicity of chemotherapy in this study was mild.     

恶性胶质瘤施行嘧啶亚硝脲化学治疗临床观察

目的：针对恶性星形细胞瘤手术后残留的肿瘤组织，用化学药物方法将其消灭和抑制生长，延长病人的生存期和改善生存质量。方法：将手术后的恶性星形细胞瘤病人施行动脉超选择灌注和静脉输液法。每日一次，２～３ｍｇ／ｋｇ。结果：１８例病人术后一年观察，未见肿瘤生长８例占４４％，不同程度复发８例占４４％，死亡２例。结论：恶性星形细胞瘤术后辅以化学药物治疗，将抑制肿瘤生长。     

Headache in children with brain tumors

To study the criteria for early differential diagnosis between migraine and headache due to brain tumors, we analyzed the symptoms and signs of two groups of children. The first group consisted of 67 children in whom a brain tumor had been diagnosed. The second group was composed of 600 children who had been diagnosed as migraine cases. Among the features of headache that are considered to be alarming symptoms of a brain tumor, the following were found to indicate a brain tumor with the greatest sensitivity: nocturnal headache or headache present on arising, both associated with vomiting, and increased frequency of headache. Nocturnal headache or headache present on arising, associated with vomiting, and/or progressive neurological symptoms or signs occurred in 65 of 67 children with brain tumor within 2 months of the onset of their headaches and in all 67 within 6 months.     

A role for preirradiation PCV chemotherapy for oligodendroglial brain tumors

Oligodendroglial tumors have been identified as a subgroup of glial neoplasms with a distinctly better response to chemotherapy and overall survival than purely astrocytic gliomas. Here we report our experience with adjuvant postirradiation and preirradiation chemotherapy using procarbazine, lomustine, and vincristine (PCV) in 27 patients with WHO grade II or III oligodendroglioma or oligoastrocytoma. The efficacy of chemotherapy was assessed according to the Macdonald response criteria (complete response, CR; partial response, PR; stable disease, SD; progressive disease, PD) and progression-free survival intervals by computed tomography or magnetic resonance imaging. First, we confirm that PCV salvage therapy for patients progressing after radiotherapy is highly effective (n = 11, 1 CR, 5 PR, 5 SD; median progression-free survival has not yet been reached, but is longer than 18 months). Second, 3 patients who received radiotherapy plus PCV as first-line therapy achieved CR and 2 achieved SD, and all 5 are progression-free with a median follow-up of 12 months. Third, given these encouraging results, 11 patients received postoperative preirradiation PCV chemotherapy and were given radiotherapy only upon progression. Preirradiation PCV chemotherapy was also effective (2 CR, 3 PR, 6 SD; median progression-free survival has not been yet reached, but is longer than 14 months). Patients with anaplastic oligoastrocytomas were as likely to respond to PCV chemotherapy, as were patients with anaplastic oligodendroglioma. Three patients who had previously responded to PCV were successfully treated with a second course of PCV upon recurrence. PCV chemotherapy was also effective in patients with leptomeningeal spread of oligodendrogliomas. A randomized prospective trial is required to compare the effectiveness and neurotoxicity of first-line PCV chemotherapy followed by radiotherapy to the traditional reverse sequence. Received: 20 September 1999/Received in revised form: /1 December 1999/Accepted: 31 December 1999     

Cognitive impairment and quality of life in long-term survivors of malignant brain tumors

Thirtysix long-term survivors following the treatment of a malignant supratentorial brain tumor were examined for cognitive functions and global level of autonomy. Eighteen patients were symptom-free (SF) and 18 had clinical and neuroradiological recurrence (RE). The control group included 30 healthy subjects. All subjects underwent a neuropsychological battery for general and specific cognitive functions. The level of autonomy was assessed by means of the Karnofsky Performance Scale (KPS) for oncological patients. SF patients showed less impairment than RE patients both at the tests, as well as on the KPS. The cognitive deficits were subclinical in most SF patients, the tests for attention, memory and word fluency being the most sensitive in detecting subtle dysfunctions. The association between tumor location and specific cognitive deficits was inconstant in both patient groups. The results suggest that even subtle cognitive deficits can prevent SF long-term survivors from returning to premorbid autonomy and occupations, and that neuropsychological tests may be used as complementary routine indicators of their quality of life. Furthermore, our data show that, in selected patients, combined treatments and therapeutic insistence do not necessarily have the same deleterious effects.

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Sommario Trentasei pazienti, lungosopravviventi dopo il trattamento per un tumore sopratentoriale maligno, sono stati sottoposti ad und valutazione delle funzioni cognitive e del livello globale di autonomia. Diciotto pazienti erano asintomatici e 18 presentavano recidiva clinica e radiologica. Come gruppo di controllo sono stati esaminati 30 soggetti sani. Tutti i soggetti sono stati sottoposti ad una batteria neuropsicologica per la valutazione di funzioni cognitive generali e specifiche. Il livello di autonomia è stato definito mediante la scala di Karnofsky per pazienti oncologici. I pazienti asintomatici hanno mostrato una minore compromissione sia delle funzioni cognitive che del livello di autonomia rispetto a quelli con recidiva. I deficit cognitivi sono risultati modesti nella maggior parte dei pazienti asintomatici ed i test di attenzione, fluenza verbale e memoria sono apparsi i più sensibili nel rilievo di disfunzioni subcliniche. L'associazione tra sede del tumore e deficit cognitivi specifici è risultata incostante in entrambi i gruppi di pazienti. I risultati suggeriscono che deficit cognitivi anche lievi possono impedire il completo recupero dell'autonomia e delle attività premorbose nei lungosopravviventi asintomatici e che i test neuropsicologici possono fornire indici complementari nella valutazione routinaria della qualità di vita. I nostri dati inoltre mostrano che, in pazienti selezionati, l'insistenza terapeutica non induce necessariamente effetti deleteri.