三维适形放射治疗联合替莫唑胺治疗高级别脑胶质瘤  

Three-dimensional conformal radiotherapy combined with temozolomide in treatment of high-grade glioma

作　　者：季海峰[1] 赵帆[1] 陈暑波[1] 张迦维[1] 

机构地区：[1]南京医科大学附属无锡第二医院肿瘤科,江苏无锡412002

出　　处：《实用肿瘤杂志》2012年第4期382-385,共4页Journal of Practical Oncology

摘　　要：目的观察三维适形放射治疗(three-dimensional conformal radiotherapy,3D-CRT)联合替莫唑胺(temozolomide,TMZ)治疗高级别脑胶质瘤(high-grade glioma,HGG)的临床疗效。方法 65例术后HGG随机分成TMZ联合3D-CRT组(治疗组)和单纯3D-CRT组(对照组)。治疗组35例(WHO分级Ⅲ级21例,Ⅳ级14例),对照组30例(Ⅲ级18例,Ⅳ级12例)。头颅适形放疗DT60 Gy/(30 f.42 d),治疗组同时每日服用TMZ 75 mg/m2,直到放疗结束。随后用TMZ辅助化疗6疗程,150～200 mg/(m2.d)×5天,每28天重复。对照组按照上述放疗方案进行。结果 治疗组:1、2、3年生存率分别为88.6%(31/35)、45.7%(16/35)、25.7%(9/35),中位生存期20月。对照组:1、2、3年生存率分别为43.3%(13/30)、16.7%(5/30)、6.7%(2/30),中位生存期12月。两组1、2、3年生存率及3年间总的生存率和中位生存期比较差异均有统计学意义(P<0.05)。两组血液学毒性和放射性脑损伤症状均可耐受。结论 与单纯3D-CRT比较,3D-CRT联合TMZ化疗提高了HGG的生存率。Objective To evaluate the efficacy of three-dimensional conformal radiotherapy （3D-CRT） combined with temozolomide （TMZ） in treatment of high-grade glioma （HGG）. Methods Sixty five postoperative patients with high-grade glioma were randomly divided into 3D-CRT with TMZ group （combination group） and 3D-CRT alone group （control group）. There were 35 cases in combination group, including 21 cases with grade 111,14 cases with grade IV ; 30 cases in control group,including 18 cases with grade 111 and 12 cases with grade IV. Three-dimensional conformal radiation therapy for brain was given at DT 60 Gy/30 f for 42 d. Patients in combination group also received concomitant 75 mg/mE/d TMZ until the end of radiotherapy, followed by 6 courses of adjuvant chemotherapy with 150 - 200 mg/（ mE · d） TMZ × 5 d： this was repeated every 28 d. The control group followed the same radiotherapy plan as described above. Results For combination group,the 1-,2- and 3-y survival rates were 88.6% （31/35） ,45.7% （ 16/35 ） and 25.7 % （ 9/35 ） respectively, with a median survival time of 20 months. For control group, the 1 -, 2- and 3-y survival rates were 43.3 % （13/30） , 16.7% （ 5/30 ）, and 6.7% （ 2/30 ） respectively, with a median survival time of 12 months （ all P 〈 0.05 ）. Hematological toxicity and symptoms of radiation-induced brain injury were tolerable in both groups. Conclusion 3D-CRT combined with TMZ chemotherapy improves the survival rates of high grade malignant glioma compared to 3D-CRT alone.

关 键 词：脑肿瘤/放射疗法 脑肿瘤/药物疗法 神经胶质瘤/放射疗法 神经胶质瘤/药物疗法 放射疗法 适形/方法 存活率 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]