Artikel
Chemoresistance in malignant gliomas – clinically relevant?
Chemoresistenz bei malignen Gliomen – klinische Relevanz?
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Autoren
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R. Buchalla
- Neurochirurgische Klinik, DIAKO Flensburg
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K. Kuchelmeister
- Institut für Neuropathologie, Justus-Liebig-Universität Gießen
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W. Schachenmayr
- Institut für Neuropathologie, Justus-Liebig-Universität Gießen
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Malignant gliomas show individual chemoresistance profiles. Regarding new chemotherapeutic drugs we examined whether a drug sensitivity assay (DSA) could help to treat responders more efficiently or if it would be reasonable to abandon such drugs when resistance is proven.
Methods: 51 tumor specimens were cultivated and subjected to a MTT-DSA. The 10 WHO III malignant glioma patients had been operated, irradiated and all of them had at least one chemotherapy. The 41 WHO IV malignant glioma patients were operated and irradiated, 16 had chemotherapy, 25 were not treated with chemotherapy. The test results, time-to-progression (TTP) and overall survival (OS) following different therapies were statistically evaluated.
Results: Multiresistance was demonstrated in 10% WHO III and 19,5% WHO IV tumors. There was a high resistance against nitrosoureas and temozolomide (TMZ). Resistance against nitrosoureas was lower in WHO IV tumors but there was no difference concerning TMZ. An average resistance under 50% could be seen against paclitaxel in both groups. The median TTP of the WHO III patients (n=10), who all had chemotherapy was 24,42 months with a median OS of 108 months. The median OS in the WHO IV tumor group without chemotherapy (n=25) and with chemotherapy (n=16) was 4 months and 16 months respectively, which differs significantly (t-test p=0,005). Mean TTP after the first chemotherapy was 7 months. There was no significant correlation between the number of sensitivity proven drugs and TTP or OS. Mostly TMZ was prescribed. TTP and OS of those patients who had a chemotherapy at least partially considering results of DSA (WHO III – 4 cases, WHO IV – 8 cases) do not differ significantly from those who received a standard chemotherapy.
Conclusions: The DSA results alone were not prognostically significant criteria in respect to TTP or OS. Our treatment results obviously were the best achievable results following a therapy with drugs that had been proven not to be tumor effective in the DSA in most cases. Since these treatment results are significantly superior to those without chemotherapy, it is unreasonable to abandon chemotherapy even if resistance is shown.
