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A
comparison of treatment results for recurrent malignant gliomas
Nieder C, Grosu AL, Molls M
Department of
Radiation Oncology, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22,
Munich, 81675, Germany.
Retreatment of malignant gliomas may be performed with palliative intent after
careful consideration of the risks and benefits, and with special regards to
iatrogenic neurotoxicity and quality of life (QOL).
This review compares studies of several retreatment strategies (published
between 1987 and 2000) based on the quality of their evidence.
Depending on both established prognostic factors and previous treatment,
individually tailored retreatment strategies are possible.
In all studies that included a multivariate analysis of prognostic factors,
performance status was the most important.
So far, predictive factors for response, which might facilitate patient
selection, have not been unequivocally defined.
In terms of QOL, single-agent chemotherapy (temozolomide, nitrosoureas, platinum
and taxane derivatives) may offer a better therapeutic ratio than
polychemotherapy.
For glioblastoma multiforme, progression-free survival and QOL were more
favourable after temozolomide than procarbazine (level 1 evidence).
The survival of patients after various radiotherapy techniques is broadly
similar.
However, considerable toxicity is associated with radiosurgery or
brachytherapy.
Fractionated stereotactic radiotherapy plus radio-sensitizing cytostatic agents
has shown promising initial results in small groups of selected patients and
awaits further evaluation.
Level 2 evidence derived from non-randomized studies does not suggest a
substantial prolongation of survival by re-resection as compared with
chemotherapy or radiotherapy alone.
Level 1 evidence derived from a randomized trial suggests that application of
BCNU polymers significantly improves the outcome after re-resection.
However, most studies reported median survival in the range of only 25-35 weeks,
thereby emphasizing the need for the development and clinical evaluation of new
innovative treatment approaches.
Copyright 2000 Harcourt Publishers Ltd.
PMID:
11139371 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11139371&dopt=Abstract
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