Does Early Postsurgical Temozolomide Plus Concomitant Radiochemotherapy Regimen Have Any Benefit in Newly-diagnosed Glioblastoma Patients? A Multi-center, Randomized, Parallel, Open-label, Phase II Clinical Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The radiochemotherapy regimen concomitantly employing temozolomide (TMZ) chemotherapy and radiotherapy (RT) 4 weeks after surgery, followed by 6 cycles of TMZ is a common treatment for glioblastoma (GBM). However, its median overall survival (OS) is only 14.6 months. This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen.</p><p><b>METHODS</b>A randomized, parallel group, open-label study of 99 newly diagnosed GBM patients was conducted at 10 independent Chinese neurosurgical departments from June 2008 to June 2012. Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide (early TMZ group) or standard concomitant radiochemotherapy regimen (control group). Overall response was assessed based on objective tumor assessments, administration of corticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event (AE), and neurological condition were measured for 24 months of follow-up. The primary efficacy endpoint of this study was overall survival (OS). The secondary endpoint was progression free survival (PFS).</p><p><b>RESULTS</b>The median OS time in the early TMZ group was 17.6 months, compared with 13.2 months in the control group (log-rank test P = 0.021). In addition, the OS rate in the early TMZ group was higher at 6, 12, and 18 months than in the control group, respectively (P < 0.05). The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group (log-rank test P = 0.695). AEs occurred in 29 (55.8%) and 31(73.8%) patients respectively in early and control groups, including nausea (15.4% vs. 33.3%), vomiting (7.7% vs. 28.6%), fever (7.7% vs. 11.9%), and headache (3.8% vs. 23.8%). Only 30.8% and 33.3% were drug-related, respectively.</p><p><b>CONCLUSIONS</b>Addition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated and significantly improved the OS of the GBM patients, compared with standard concomitant radiochemotherapy regimen. However, a larger randomized trial is warranted to verify these results.</p>

Microsurgery and comprehensive treatment strategies for callosal gliomas / 第二军医大学学报

Objective: To investigate the clinical characteristics, microsurgery feasibility and postoperation comprehensive treatment strategy of callosal gliomas, so as to improve the prognosis of patients. Methods: The clinical manifestations, diagnoses, microsurgical approaches, chemotherapy and radiotherapy, and prognoses of 82 callosal gliomas patients, who were treated in our hospital during January 1995 and December 2007, were retrospectively analyzed. The optimal surgical approach and resection strategies were chosen preoperativety according to the imaging features of tumors. Resections were performed and the navigational orientation was used during operation in 8 cases, type-B ultrasonic supervision was used in 4 cases, and cavitron ultrasonic surgical aspirator (CUSA) was used in 5 cases. Patients with tumors above grade U underwent chemotherapy (temposide + semustine) and radiotherapy designated individually according to the pathological grades and involvement of gliomas. The follow-up study was conducted by telephone, mail or outpatient department visits. Results: The clinical manifestations of the 82 patients included headache and vomiting (n=44), epilepsy (n=16), mental symptoms (n=12), and mild plasy (n=20). Resections were performed via the longitudinal fissure approach in 44 cases, via the transcortical approach in 24 cases, and via the longitudinal fissure and transcortical combined approach in 5 patients; 7 patients received stereotactic biopsy and 2 patients only received chemotherapy and radiotherapy. Six patients had tumors found in the rostrum of corpus callosum, 36 in the genu of corpus callosum, 30 in the body of corpus callosum, and 10 in the splenium of corpus callosum. Total surgical resection was performed in 45 cases, subtotal in 13 cases, and partial in 15 case. Pathological findings confirmed astrocytoma in 48 cases, oligodendroglioma in 11 cases, ependymoma in 2 cases, and glioblastoma in 19 cases. The follow-up of 61 patients indicated that 89% patients survived for over 1 year, 71% survived for over 2 years, 62% survived for over 3 years and 39% survived for over 5 years, with a median survival time being 47 months and the longest survival time being 140 months. COX regression analysis found that elder age, higher pathology grade and incomplete resection were associated with poor prognosis. Conclusion: The callosal gliomas locate at especial position, and the anatomic characteristic, adjacent structure, blood supply should be fully understood before operation. Accurate surgical approaches assisted by appropriate therapeutic strategies can improve the prognosis of the patients. The longitudinal fissure approach is commonly used. The proficient microsurgical technique combined with navigation and type-B ultrasonic can improve the resection outcome and prognosis of patients.

Study on metastasis-associated gene in carcinoma by cDNA microarray / 第二军医大学学报

Objective:To understand the molecular pat hophysiology of hepatocellular carcinoma and pancreatic cancer.Methods: We studied novel gene expression by cDNA microarray method. The PCR pro ducts of 4 096 genes and 12 800 gene were spotted onto a kind of chemical-mater ial-coated-glass slide in array. Both the mRNAs from 5 cases of hepatocellular carcinoma and 3 cases of pancreatic cancer were reversely transcribed to cDNAs with the incorporation of fluorescent-labeled dUTP to prepare the hybridization probes. After hybridization, BioDoor4096 and BioDoor12800 cDNA microarray were scanned for the fluorescent intensity. Tumor invasion-related gene expression w as screened through the analysis of difference in gene expression profile.Results:Among 4 096 and 12 800 target genes, there were 15 genes who se expression level differed from normal and carcinoma tissues. Therefore, they might be associated with metastasis.Conclusion:Further analysis of these differentially expressed metastasis-associated genes will be helpful for understanding the molecular mechanism of malignant carcinoma.

Study on metastasis-associated gene in carcinoma by cDNA microarray / 第二军医大学学报

Objective:To understand the molecular pat hophysiology of hepatocellular carcinoma and pancreatic cancer.Methods: We studied novel gene expression by cDNA microarray method. The PCR pro ducts of 4 096 genes and 12 800 gene were spotted onto a kind of chemical-mater ial-coated-glass slide in array. Both the mRNAs from 5 cases of hepatocellular carcinoma and 3 cases of pancreatic cancer were reversely transcribed to cDNAs with the incorporation of fluorescent-labeled dUTP to prepare the hybridization probes. After hybridization, BioDoor4096 and BioDoor12800 cDNA microarray were scanned for the fluorescent intensity. Tumor invasion-related gene expression w as screened through the analysis of difference in gene expression profile.Results:Among 4 096 and 12 800 target genes, there were 15 genes who se expression level differed from normal and carcinoma tissues. Therefore, they might be associated with metastasis.Conclusion:Further analysis of these differentially expressed metastasis-associated genes will be helpful for understanding the molecular mechanism of malignant carcinoma.