Multimodale Therapie maligner Gliome Ergebnisse einer Untersuchung der Wirksamkeit einer kombinierten Radio-Chemotherapie mit Topotecan

Ziel der „Kombinierten Strahlen- und Chemotherapie maligner Hirntumoren mit Hycamtin®“ war es, die Ergebnisse der Strahlentherapie durch den gezielten Einsatz eines Zytostatikums zu verbessern. Die Hauptfragestellungen waren die Erfassung der Verträglichkeit der Behandlung und die Auswirkungen auf d...

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Bibliographic Details
Main Author: Pause, Riglef
Contributors: Engenhart-Cabillic, Rita (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2005
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The goal of „radiating and chemotherapy combined of the malignant brain tumors with Hycamtin® “were it to improve the results of the radiotherapy by the purposeful employment of a cytostatic drug. The main question positions were the collection of the compatibility of the treatment and the effects on the quality of life of the patients. As further questions the length of time of tumor control were documented, as well as surviving compared with a historical, only radio therapy ores control's group regarded. An improvement of the therapy result with the treatment of Glioblastomen appears radiate-sensitizing by application one to DNS level working cytostatic drug possible. For this a combined radio chemotherapy with Topotecan could be suitable, because this substance • jet sensitivity increases, • is able to get into the liquor • and no neurotoxic characteristics possesses. Into the therapy optimization with Topotecan altogether 60 patients from five different hospitals were transferred, from which 57 terminated the treatment. The quality of life, as well as surviving were documented to diagnostic position. Additionally it came to the collection of local tumor control and the unwanted effects. The group of comparisons, „the historical collective “, consisted of patients of the hospital for radiotherapy of the Marburger university clinic. It covered 92 patients, who were submitted of a jet treatment because of a malignant glialen tumor WHO °III or °IV. Here the survival period lay to diagnostic position between one month (minimum) and 91 months (maximum). The middle (± SEM = standard error of the average value) survival period amounted to 17 ± 2.0 months, the median amounted to 10 months. The 1-term-survival was about 41%. A differentiation between WHO °III and °IV resulted in a clearly better prognosis for the Gliome °III WHO. Surviving to diagnostic position of the patients of the therapy optimization with Topotecan amounted to in the median 15.0 months. The 1-term-survival was about 61%. The minimum of surviving amounted to 2 months, the maximum was found at 31 months. In the comparison to the historical control's group the result was significantly more favorable. The unwanted effects of the therapy optimization with Topotecan were altogether small. The compatibility was good. In 17 cases a decrease of the hemoglobin concentration was to be determined, without degree of III or a IV toxicity arose. A toxicity with degrees of IV or V gave it altogether only four times. At infectious complications two patients deceased during the therapy. The Karnofsky-index fell during the treatment in the median significantly from 90 to 80, reached the initial value however during the first re-examination again. During the duration of the radiotherapy was to be recognized also a significant waste of the Spitzer-index. Up to the time of the first re-examination initials the level of the Spitzer-index was however easily exceeded. After the combined radio chemotherapy with Topotecan was significantly longer mediane surviving than in the historical control's group. This result is critical of judging, it could partly by the unequal distribution of the dimension of the operation and recruiting of patients in good general state with an Karnofsky-index of at least 70 avowed be. The influence of the quality of life under the therapy was small. The treatment with Topotecan was altogether well compatible and brought only an easy, short term restriction of the quality of life with itself. The combined therapy is also ambulatory feasible.