Continuous Low-Dose Temozolomide Chemotherapy and Microvessel Density in Recurrent Glioblastoma.
10.3340/jkns.2015.58.5.426
- Author:
Jong Yun WOO
1
;
Seung Ho YANG
;
Youn Soo LEE
;
Su Youn LEE
;
Jeana KIM
;
Yong Kil HONG
Author Information
1. Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. hongyk@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Glioblastoma;
Temozolomide;
Metronomic chemotherapy;
Microvessel density
- MeSH:
Disease-Free Survival;
Drug Therapy*;
Glioblastoma*;
Humans;
Microvessels*;
Recurrence;
Reoperation
- From:Journal of Korean Neurosurgical Society
2015;58(5):426-431
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of continuous low-dose temozolomide (TMZ) chemotherapy for recurrent and TMZ-refractory glioblastoma multiforme (GBM) and to study the relationship between its efficacy and microvessel density within the tumor. METHODS: Thirty patients who had recurrent GBM following Stupp's regimen received TMZ daily at 50 mg/m2/day until tumor progression between 2007 and 2013. The median duration of continuous low-dose TMZ administration was 8 weeks (range, 2-64). RESULTS: The median progression-free survival (PFS) of continuous low-dose TMZ therapy was 2 months (range, 0.5-16). At 6 months, PFS was 20%. The median overall survival (OS) from the start of this therapy to death was 6 months (95% CI : 5.1-6.9). Microvessel density of recurrent tumor tissues obtained by reoperation of 17 patients was 22.7+/-24.1/mm2 (mean+/-standard deviation), and this was lower than that of the initial tumor (61.4+/-32.7/mm2) (p-value=0.001). It suggests that standard TMZ-chemoradiotherapy reduces the microvessel density within GBM and that recurrences develop in tumor cells with low metabolic burden. The efficacy of continuous low-dose TMZ could not be expected in recurrent GBM cells in poor angiogenic environments. CONCLUSION: The efficacy of continuous low-dose TMZ chemotherapy is marginal. This study suggests the need to develop further treatment strategies for recurrent and TMZ-refractory GBM.
