VM26联合MeCCNU在人脑低级别胶质瘤治疗中应用的初步探讨  

Primary exploration of the efficiency of VM26 combined with MeCCNU therapy for the low-grade gliomas

作　　者：曹广辉[1] 谭卫国[1] 冯鸣[1] 申昊[1] 王君祥[1] 黄煜伦[1] 周幽心[1] 

机构地区：[1]苏州大学附属第一医院神经外科,215000

出　　处：《临床神经外科杂志》2011年第1期10-12,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨人脑胶质瘤于术切除和放疗后O^6-甲基鸟嘌呤DNA甲基转移酶(MGMT)阳性的低级别胶质瘤患者应用替尼泊甙(VM26)+甲基环亚硝脲(MeCCNU)联合治疗疗效。方法总结分析我科2005.01～2008.10年收治的资料较完整、全切肿瘤22例,MRI增强扫描未见肿瘤征像,术后病理证实免疫组化MGMT阳性的弥漫性星形细胞瘤10例,少突胶质瘤3例,少突星形细胞瘤5例,室管膜瘤4例。术后2～4周后行三维适形放射治疗,剂量为50～55 Gy/6～7周。放疗后2周选择VM26为50mg/m^2/d,连续3d静脉滴注,8周后重复,进行3个周期;Me-CCNU为50 mg/m^2/d,连续3d口服,8周后重复,持续4个周期。并定期复查MRI。结果 MGMT、TopoⅡ_α及Pgp染色,TopoⅡ_α及Pgp同时阳性者6例,仅TopoⅡ_α阳性者10例,仅PgP阳性者2例,TopoⅡ_α及Pgp同时阴性者4例。随访2～5年,22例中有6例肿瘤复发,平均复发时间16.6月,13例至今头颅CT和/或MRI检查未见肿瘤复发,另有3例2年后MRI怀疑复发而手术,病理为坏死组织。22例患者1年生存率为100%,2年生存率为88.9%。结论脑胶质瘤手术切除和放疗后MGMT阳性的低级别胶质瘤患者应用VM26联合MeCCNU治疗方案能有效地控制肿瘤,并且毒副作用小,安全可靠,是有效的治疗方法。Objective To explore the efficiency of VM26 combined with MeCCNU therapy for the low-grade gliomas of MGMT-positive after tumor resection and radiotherapy. Methods The clinical data of 22 patients with MGMT-positive who underwent total removal of tumors with enhanced MRI imaging showing no residual tumors from Jan 2005 to Oct 2008 in our department were analyzed retrospectively. Of 22 patients, 10 were diffuse astrocytomas; 3 were oligodendrogliomas;5 were are mixed oligo-astrocytomas and 4 ependymomas. These patients received three-dimensional conformal radiotherapy 2-4 weeks after surgery with radiation and exposure dose being （50-55） Gy/（6 -7） weeks. 2 weeks after the end of radiotherapy, these patients underwent VM26 combined with MeCCNU therapy （ VM26 ： 50mg/m2/day, intravenous dripping for 3 days, repeated after 8 weeks for 3 cycles. MeCCNU： 50mg/m2/day, taken orally for 3 days, repeated after 8 weeks for 4 cycles） with MRI scanning regularly. Results Of 22 MGMT-positive grade Ⅱ gliomas, 6 cases were positive for both TopoⅡaand Pgp, 10 and 2 were only positive for TopoⅡa and Pgp, respectively; and 4 were negative for both TopoⅡa and Pgp. The following up from 2 to 5 years showed tumors recurred in 6 cases with average time of recurrence being 16.6 months,CT or MRI imaging showed no tumor recurrence in 13 , 3 underwent the second surgery due to MRI imaging showing possible tumor recurrence 2 years after prior surgery. Pathological examination reported suspected recurring tumor was necrotic tissue. In these 22 patients , one year survival rate of one year was 100% and two years was 88.9%. ConclusionsVM26 combined with MeCCNU chemotherapy is able to efficaciously inhibit the growth of gliomas, with little side-effects,safety. It＇s an therapeutic method for patients with low-grade MGMT-positive gliomas aftert tumor resection and radiotherapy.

关 键 词：胶质瘤 化学治疗 

分 类 号：R739.4[医药卫生—肿瘤]