[不能切除脑膜瘤的羟基脲治疗]。

PubMed ID
发表日期 2004年Sep月

原始出处 神经外科
Neuro-Chirurgie
作者 Fuentes  S  Chinot  O  Dufour  H  Paz-Paredes  A  Métellus  Ph  Barrie-Attarian  M  Grisoli  F 

文献标题 [不能切除脑膜瘤的羟基脲治疗]。
[Hydroxyurea treatment for unresectable meningioma].

文献摘要 BACKGROUND

治疗不可切除的进行性脑膜瘤仍然存在争议,并构成了一个重大挑战,因为包括化疗和激素调节的治疗选择是有限的。最近的数据表明,羟基脲治疗可能有抗肿瘤的作用。这项前瞻性II期研究的目的是评估羟基脲治疗不能切除的进行性脑膜瘤的疗效。

METHODS

从1997年到1999年,连续出现临床和/或神经放射学证实进展的不可切除脑膜瘤的患者被考虑加入该方案。既往放疗不是强制性的纳入标准。治疗包括连续口服羟基脲,剂量为20毫克/千克/天。随访评估包括每三个月进行一次体格检查、计算机断层扫描(CT)和磁共振成像(MRI),以及定期血液检查。主要终点是通过MRI或CT记录客观反应。

RESULTS

意向治疗人群为43例,随访至少18个月。中位年龄为60.4岁。28名患者在初步诊断后接受了手术。67%的患者脑膜瘤位于颅底。组织学良性18例,不典型10例。符合条件的人群包括36例在纳入时有进展性疾病记录的患者;29例(67.5%)有进展性疾病的临床记录和/或20例(46%)有进展性疾病的放射记录。7例患者的临床或影像学进展不能得到证实。平均26个月随访的意向性治疗分析显示,只有3例(7%)患者对羟基脲有客观反应,其中1例是基于视觉症状的改善,2例是基于MRI分析。26例(60.5%)在临床或放射学上观察到进展性疾病。在符合条件的人群中(n=36),2人在羟基脲治疗下取得客观疗效,13人(36%)在羟基脲治疗下表现稳定,21人(58%)在治疗下取得进展。总体耐受性良好,但贫血(I-II级)和乏力(I-II级)分别为28%和23.5%。3例因慢性皮肤毒性1例,贫血乏力2例而停止治疗。

CONCLUSION

羟基脲治疗脑膜瘤的疗效微乎其微,如果放射治疗或手术是可行的,就不能作为替代治疗。进行性脑膜瘤仍需要新的有效治疗方法。


BACKGROUND

Management of unresectable progressive meningioma remains controversial and constitutes a major challenge since therapeutic options including chemotherapy and hormone modulation are limited. Recent data have suggested that hydroxyurea treatment may have an antitumoral effect. The purpose of this prospective phase II study was to evaluate the efficacy of hydroxyurea treatment for unresectable progressive meningioma.

METHODS

From 1997 to 1999, consecutive patients presenting unresectable meningioma with clinically and/or neuroradiologically documented progression were considered for entry into this protocol. Previous radiotherapy was not a mandatory inclusion criteria. Treatment consisted of continuous oral administration of hydroxyurea at a dose of 20 mg/kg per day. Follow-up assessment included physical examination, computed tomography (CT), and magnetic resonance imaging (MRI) performed every three months, as well as regular blood testing. The primary endpoint was documentation of objective response by MRI or CT.

RESULTS

The intent-to-treat population was 43 patients with at least 18 months follow-up. Median age was 60.4 years. Twenty-eight patients had undergone surgery following initial diagnosis. The meningioma was located in the skull base in 67% of patients. Histology was benign in 18 and atypical in 10. The eligible population included 36 patients with documented progressive disease at the time of inclusion; with progression documented clinically in 29 (67.5%) and/or radiologically in 20 (46%). In 7 patients, clinical or radiological progression could not be confirmed. The intent-to-treat analysis at median 26 months follow-up revealed objective response to hydroxyurea in only 3 patients (7%) including one on the basis of improvement in visual symptoms and two on MRI analysis. Progressive disease was observed clinically or radiologically in 26 patients (60.5%). Of the eligible population (n=36), 2 achieved an objective response and 13 (36%) exhibited stabilization under hydroxyurea therapy, while 21 (58%) progressed under treatment. Overall tolerance was good but anemia (grade I-II) and asthenia (grade I-II) were observed in 28% and 23.5% respectively. Treatment was discontinued in 3 patients because of chronic skin toxicity in one and anemia and asthenia in two.

CONCLUSION

Hydroxyurea treatment is of marginal efficacy for meningioma and must not be considered as an alternative if radiotherapy or surgery is feasible. New efficient medical treatments are still required for progressive meningiomas.


获取全文 10.1016/s0028-3770(04)98326-9