替莫唑胺联合放疗治疗18例初诊高级别脑胶质瘤患者的临床观察  

Clinical observation of temozolomide combined with radiotherapy for 18 cases of newly diagnosed high grade gliomas

作　　者：吴学勇[1] 张玺炜[1] 殷晓峰[1] 赵子仪[1] 

机构地区：[1]上海市静安区中心医院肿瘤科,上海200040

出　　处：《中国癌症杂志》2009年第4期288-291,共4页China Oncology

摘　　要：背景与目的:高级别脑胶质瘤(HGG)病程发展快,死亡率高,寻找新的治疗方法和开发新的化疗药物成为目前这种疾病研究的热点。本研究通过观察替莫唑胺同步放疗加单药辅助化疗治疗初诊高级别脑胶质瘤的疗效和安全性,对替莫唑胺一线治疗脑胶质瘤的临床获益性进行探讨。方法:采用60Co对18例HGG患者进行全脑(DT40Gy/20f)加局部小野(DT20Gy/10f)照射DT60Gy/30f×6周,放疗期间每日口服替莫唑胺75mg/m2,放疗结束后4周,继续给予替莫唑胺标准5d方案辅助化疗6个周期,每一周期28d。第1周期用量150mg/m2,连用5d,无明显血液毒性后,从第2周期起剂量增至200mg/m2。结果:18例高级别脑胶质瘤患者中位随访12.5个月,11例出现复发或进展,5例死亡。中位疾病无进展生存期为9.8个月(95%CI,6.1～9.8个月),中位总生存时间为14个月(95%CI,8.5～19.5个月),1年总生存率为55.6%,6个月疾病无进展生存率为81.8%。替莫唑胺不良反应发生率低,以轻度血液毒性为主。结论:替莫唑胺联合同步放疗加后续单药辅助化疗治疗初诊高级别脑胶质瘤有较好的临床疗效,本疗法安全性好,患者能够从中受益。Background and purpose： The prognosis of high grade gliomas remains poor, and multidisciplinary treatment strategy has been much investigated recently. This study was to explore the efficacy of Temozolomide as first-line treatment combined with radiotherapy and followed by adjuvant chemotherapy for the treatment of newly diagnosed high grade gliomas. Methods： 18 patients who had been pathologically proven to be high grade gliomas were enrolled into the study. The patients received 40 Gy/20fractions for the whole brain and followed by 20Gy/10fractions as a boost to tumor bed. All of the patients were given daily oral temozolomide 75mg/m^2 during radiotherapy. 4 weeks after radiotherapy, all of the patients received 6 cycles of Temozolomide, each cycle lasted 5 days with 28 days interval between each cycles. 150 mg/m^2 of temozolomide was given for the first cycle for five days,followd by 200 mg/m^2 of drug for the rest of the cycles if no significant drug related toxicities were observed. Results： Median follow-up was 12.5 months, 11 cases had either recurrence or progression, 5 of them died from the disease. The median time for disease progression-free survival was 9.8 months （95% CI, 6.1-9.8months）, the median time for overall survival was 14 months （95% CI, 8.5 - 19.5months）, 1-year overall survival rate was 55.6% ,6-month progression-free survival rate was 8i.8%. there were no severe temozolomide related toxicities. Conclusion： Concurrent temozolomide with radiotherapy and followed by 6 cycles of temozolomide in the treatment of high grade gliomas had better clinical efficacy, the patients tolerated the strategy well and no severe toxicities were observed.

关 键 词：替莫唑胺 放疗化疗 高级别脑胶质瘤 

分 类 号：R739.41[医药卫生—肿瘤] R730.58[医药卫生—临床医学]