术后复发性脑胶质瘤治疗新策略——脉冲式低剂量率再程放疗  

A new strategy for the treatment of postoperative recurrent glioma:pulse low-dose rate re-radiotherapy

作　　者：周培杰 李云天 包娅薇 郭丹玉 钱中润 ZHOU Peijie;LI Yuntian;BAO Yawei;GUO Danyu;QIAN Zhongrun(Department of Tumor Radiotherapy,The First Affiliated Hospital of USTC,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院肿瘤放疗科,合肥230001 [2]中国科学技术大学附属第一医院神经外科,合肥230001

出　　处：《临床神经外科杂志》2024年第4期402-406,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金青年科学项目(82102953)。

摘　　要：目的 评估脉冲式低剂量率(PLDR)再程放疗联合贝伐珠单抗及替莫唑胺治疗复发性脑胶质瘤的疗效。方法 回顾性分析中国科学技术大学附属第一医院肿瘤放疗科2020年3月—2022年12月收治的51例术后放疗后复发的脑胶质瘤患者,其中PLDR放疗联合贝伐珠单抗及替莫唑胺治疗组(实验组)24例,贝伐珠单抗及替莫唑胺治疗组(对照组)27例。PLDR再程放疗方案为处方剂量DT 50~54 Gy,2 Gy/次,分10个脉冲照射,脉冲间隔时间为3 min,剂量率为0.067 Gy/min,单次治疗时长为30 min。放疗前后分别检测外周血CD4^(+)和CD8^(+)T淋巴细胞水平,放疗后1个月复查头颅核磁共振成像(MRI)评估病灶消退情况,此后每3个月定期复查。结果 与单纯内科治疗组相比,PLDR组延长中位无进展生存期(PFS)时间(分别为7.9个月和5.9个月,P<0.05),且并未显著增加患者二次放疗副反应;PLDR组患者治疗后外周血中CD4^(+)T细胞(分别为42.62%和33.31%,P<0.05)和CD8^(+)T细胞(分别为38.53%和26.25%,P<0.05)比例均显著升高。结论 术后放疗后复发的胶质瘤患者采用PLDR再程放疗联合贝伐珠单抗及替莫唑胺有助于提高疗效并激活机体免疫反应。Objective To evaluate the efficacy of pulse low-dose rate(PLDR) combined with bevacizumab and temozolomide in the treatment of recurrent glioblastoma.Methods Fifty-one patients with recurrent glioma after postoperative radiotherapy admitted to the Department of Tumor Radiotherapy,First Affiliated Hospital of University of Science and Technology of China from March2020 to December 2022 were analyzed retrospectively,including 24 patients in the experimental group treated with PLDR combined with bevacizumab and temozolomide,and 27 patients in the control group treated with bevacizumab and temozolomide.PLDR radiotherapy regimen consisted of a prescription dose of DT 50-54 Gy,2 Gy/dose,divided into 10 pulse radiation,with the pulse interval time of 3 minutes,a dose rate of 0.067 Gy/min,and a single treatment duration of 30minutes.Peripheral blood CD4~+and CD8~+T lymphocyte levels were measured before and after radiotherapy.One month after radiotherapy,head magnetic resonance imaging(MRI) was performed to evaluate the regression of recurrent lesions,and patients were evaluated every 3 months thereafter.Results Compared with the chemotherapy group alone,progression free survival(PFS)was significantly improved by PLDR+temozolomide(7.9 months vs 5.9 months,P <0.05).The combined regimen did not significantly increase the incidence of side effects of secondary radiation.The proportion of CD4~+T cells(42.62% vs 33.31%,P <0.05) and CD8~+T cells(38.53% vs26.25%,P <0.05) in the peripheral blood of patients in the experimental group was significantly increased.Conclusions The application of PLDR combined with temozolomide in patients of recurrent glioma post-surgery and radiotherapy can improve therapeutic efficacy and activate the immune response of patients.

关 键 词：复发 胶质瘤 再程放疗 脉冲式低剂量率放疗 

分 类 号：R739.41[医药卫生—肿瘤]