Health Worlds

Olympic joy of success disappeared, neurosurgery, radiotherapy, oncology experts has gathered in the Schering-Plough (China) Co., Ltd. support, held in a venue based in Guangzhou, Chengdu, Xi'an, Hangzhou, Suzhou Session of the five cities for the joint network of video conferencing. Morning and afternoon meetings were painted by the Professor Lu Taixiang and Greenfield, Professor Luo Rongcheng chaired the University of Wisconsin School of Medicine (Minesh Mehta) and domestic experts, Professor, respectively, gave a speech focused on the treatment of brain tumors progress.
The experts stressed that surgery combined with postoperative radiotherapy and chemotherapy in multimodality therapy model is the future treatment of brain tumor development trend of increasing surgery, chemotherapy and radiation therapy technology and the development of targeted drug benefit for patients, especially is a new oral cytotoxic alkylating agent temozolomide (Tai Road) can be effective in treating newly diagnosed and recurrent glioblastoma (GBM) and anaplastic astrocytoma (AA), prolong survival, safety and tolerability good. The drug market in China for the Chinese glioma patients new hope.
Progress in comprehensive treatment of gliomaMaximum safe resection, postoperative chemotherapy Tai Road synchronization (external irradiation 60 Gy) and then single-agent sequential chemotherapy Tai Road
GBM is the highest level of malignant brain tumors. A number of studies confirmed


that radiotherapy can improve patient survival. However, the large number of studies confirm that brachytherapy and stereotactic radiotherapy did not improve patient survival. 2002, published in "Lancet" magazine, a meta-analysis showed that compared with radiotherapy alone, concurrent chemoradiotherapy may be slightly increased in patients 1 year survival rate (from 40% to 46%).
European cancer research and treatment organizations (EORTC) conducted a Phase study compared radiotherapy alone with radiotherapy combined sync Catalonia Road Tai Road efficacy of adjuvant treatment of GBM patients, compared with radiotherapy alone, radiotherapy combined with Tai Road so that patients and median overall survival (OS) was significantly longer period (14.6 months vs. 12.1 months), 2,3,4-year survival rate significantly improved, combined radiotherapy group Tai Road 4-year survival rate of 13%, only 4% received radiotherapy, the risk ratio was 0.63 , P <0.0001 (figure).Figure Radiotherapy Tai Road chemotherapy significantly improved the survival rate of patients with newly diagnosed GBMMaximum safe resection, postoperative radiation therapy (external beam 60 Gy), relapse after chemotherapy widely Tai Road
AA patients also can benefit from radiotherapy. But studies show that compared with carmustine, PCV (procarbazine, cyclohexyl nitrosourea and vincristine) chemotherapy in patients does not make an additional benefit.
A study published in the "Journal of Clinical Oncology" (J Clin Oncol) on the phase study showed that Tai Road nitrosourea treatment drugs after treatment failure in patients with recurrent AA, 46% received 6 months progression-free survival (PFS) rate, the median OS of 13.6 months. Based on this result, FDA approved the treatment of AA and Tai Road, anaplastic glioma indications oligodendrocytes.1p or 19q gene deletion patients can benefit from the PCV program, but its toxicity can not be ignored
RTOG 9402 study compared 4 cycles of PCV neoadjuvant sequential chemotherapy radiotherapy and radiotherapy alone, EORTC 26951 study compared the 6 cycles of radiotherapy sequential standard PCV chemotherapy and radiation therapy alone. The results have shown that the two groups were not significantly different overall survival, but the 1p or 19q gene deletion in patients with significantly better survival.
Multivariate analysis, 1p or 19q loss of heterozygosity of patients are disease-free survival and OS (DFS) of the independent prognostic factors. In therapy, can not be ignored the toxicity of PCV treatment.Maximum safe resection of the tumor, early radiotherapy prolong progression-free survival
Surgery is standard treatment for such patients. RTOG 9802 study, the low-risk adult low-grade gliomas (LGG) patients in the 2-year and 5-year OS rates were 99% and 93%, PFS rates were 82% and 48%. But the combined factors of all patients with poor prognosis only 5% 5-year PFS. Even if the consolidation of all patients with good prognostic factors, the progress of its recurrence, 30% chance.
A Phase study (EORTC 22845) comparing radiotherapy patients at high risk of early and delayed radiation therapy. The results showed that patients with early radiotherapy group was significantly longer PFS (5.3 years 3.4 years, P = 0.0001), but the two groups was not significant difference in OS (7.4 years 7.2 years, P = 0.872).
Another 2006 American Society of Clinical Oncology (ASCO) annual report shows that compared with radiotherapy alone, received PCV chemotherapy combined with radiotherapy in patients with 5-year PFS rate of increase (60% vs. 42%), but the two groups of 5 years showed no significant difference in OS (71% vs. 62%).
In summary, surgery combined with postoperative radiotherapy and chemotherapy in multimodality therapy model is the primary means of combined treatment is more beneficial than non-comprehensive treatment. Based on the molecular characteristics of individual therapy will be the research priorities, although some molecular targeted drugs in patients with malignant glioma does have anti-tumor activity, but did not get a breakthrough.Operation strategy is the performance of doctors comprehensive judgment, preoperative evaluation must determine whether a comprehensive surgical indications, surgical approach adopted, revealed how patients, which should be part of diseased, how to block the tumor blood supply, Under what circumstances the tumor can be totally removed, operation must be suspended under what circumstances.
Intracranial meningiomas accounted for 13% of the primary tumor to 26%, mostly benign tumors that grow more slowly. Treated with surgical excision. However, recurrence rate is still up 7% to 32% and improve neurological surgeon, surgical treatment is an important task.
Surgery, radiotherapy and chemotherapy combined treatment is the principle of the treatment of glioma. Malignant glioma surgery is the maximum range of the most important safety removed.The incidence of lymphoma is one of the fastest-growing malignancy. Through surgery, radiotherapy, chemotherapy combined treatment of primary central nervous system lymphoma (PCNSL) patients may be cured, improved quality of life. Highly sensitive to radiotherapy in patients with PCNSL, efficiency up to 90%, stereotactic radiotherapy is preferred. However, high recurrence rate radiotherapy, chemotherapy and radiotherapy can significantly improve the outcome.
PCNSL patients on the first randomized study suggest that cytarabine (Ara-C) and methotrexate (MTX) is superior to MTX monotherapy in the treatment program (3-year event-free survival rate was 35% to 24% P = 0.02), so MTX Ara-C may be a randomized study of the control program.
A broad-spectrum anti-tumor effect of small molecule drugs Tai Road, low toxicity, easy through the blood-brain barrier, safe dose can achieve therapeutic concentrations of glioma site. Without liver metabolism Tai Road, directly in the tumor site is divided into active substances, reduces liver toxicity, bone marrow suppression of its mild adverse reactions. Were well tolerated, easy to use, suitable for combination therapy with other drugs. ASCO annual meeting this year, reported the results of a study, the use of MTX, Tai Road and rituximab combination therapy, 52.4% of PCNSL patients achieved complete remission (CR), median PFS was 11.5 months, OS not yet reached. Another study showed that Tai Road United rituximab PCNSL relapsed or resistant patients, response rate (RR) up to 53%, PFS was 7.7 months. These encouraging results need to be further explored to further improve the long-term survival of patients.
Secondary central nervous system lymphoma (SCNSL) occurred in the meninges, meningioma, etc., diagnosis is difficult. The median survival of only 2 to 5 months. Rituximab monotherapy intracranial or intrathecal injection of an effective, but the monoclonal antibody on the stimulation of large pial is not yet a standard treatment. Depending upon the patients required systemic chemotherapy decision, you can use the MTX combined Ara-C, if the pre-chemotherapy of CR, the hematopoietic stem cell transplantation prolong survival, the Thai way in the treatment may also be effective.
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