精确放疗同步替莫唑胺治疗胶质母细胞瘤疗效初探  

Preliminary clinical outcome in patients with glioblastoma treated with precise radiotherapy plus concomitant temozolomide

作　　者：陈怡东[1] 房彤[1] 蒋静[1] 陈力[1] 孙保锦[1] 邱晓光[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院放疗科,100038 [2]首都医科大学附属天坛医院

出　　处：《中华神经外科杂志》2012年第5期474-477,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨精确放疗同步替莫唑胺化疗对多形性胶质母细胞瘤的临床疗效。方法回顾性分析2009年7月至2010年12月北京世纪坛医院收治的54例多形性胶质母细胞瘤，术后接受精确放疗（三维适形或调强放疗）同步替莫唑胺化疗，随后接受替莫唑胺辅助化疗。结果全组共21例死亡，均死于肿瘤复发。全组1年总生存率为79．6％，1年无进展生存率为48．7％。32例出现复发，其中原位复发为16例。卡氏评分（KPS〉170分）组1年总生存率显著高于卡氏评分（KPS〈70分）组（86．8％与50．8％，P=0．005）。全切或近全切除组1年总生存率高于部分切除组（84．4％与70．5％，P=0．067）。仅2例出现3度以上不良反应（骨髓抑制）。结论精确放疗同步替莫唑胺化疗是多形性胶质母细胞瘤安全有效的治疗模式，卡氏评分和手术切除肿瘤的程度是影响生存的重要因素。Objective To investigate the clinical outcomes and toxicity for patients with glioblastoma multiforme （GBM） who underwent precise radiotherapy combined with temozolomide （TMZ）. Methods The records of 54 patients with newly - diagnosed GBM from July 2009 to December 2010 were reviewed. The patients underwent postoperative intensity - modulated radiotherapy （IMRT） or three - dimensional conformal radiotherapy （3D - CRT） with concurrent and adjuvant TMZ. Results The median followup was 13 months. Of the 54 patients, 50 completed the combined modality treatment. The overall survival rate was significantly different between patients with good performance status（KPS≥70） and those with worse performance status （ KPS 〈 70） （ 86. 8% VS. 50. 8%, P = 0. 005 ）. Patients who underwent partial resection had lower overall survival rate compared with those who underwent total resection, but no reach statistically significant （84.4% vs. 70. 5% , P = 0. 067）. The pattern of failure was predominantly local. Grade 3 - 4 toxicity was limited to 2 patient with leukopenia during concurrent chemoradiotherapy. Conclusions These results indicate that precise radiotherapy combined with TMZ is effective and safe treatment for GBM patients. Performance status and extent of surgery were prognostic factors for overall survival.

关 键 词：胶质母细胞瘤 多形性 三维适形放疗 调强放疗 替莫唑胺 

分 类 号：R739.4[医药卫生—肿瘤]