脑恶性胶质瘤术后会师化疗同步适形放疗的临床观察

Effects of Rendezvous Chemotherapy Combined with Three-dimensional Conformal Radiotherapy in Treatment for Post-operative Malignant Glioma

目的探讨脑恶性胶质瘤显微手术全切后间质内尼莫司汀(ACNU)与替莫唑胺(TMZ)会师化疗同步适形放疗的临床疗效和安全性。方法选取临床影像诊断为脑恶性胶质瘤的患者99例,均行开颅显微手术全切肿瘤和组织病理证实,术后采用单纯适形放疗(RT)21例,采用尼莫司汀间质化疗同步适形放疗(ACNU+RT)24例,采用替莫唑胺化疗同步适形放疗(TMZ+RT)23例,ACNU间质内化疗与口服TMZ会师化疗同步适形放疗(ACNU+TMZ+RT)31例,比较四组的疗效和安全性。结果脑恶性胶质瘤显微手术全切术后ACNU+TMZ+RT组患者1、2、3年存活率分别为80.6%(25/31)、48.4%(15/31)、25.8%(8/31),中位生存时间为29.0(39.8~18.6)月。术后1、2、3年ACNU+TMZ+RT组中位生存时间明显长于RT组、ACNU+RT组和TMZ+RT组(χL2=21.045和22.385,P=0.043和0.045);脑恶性胶质瘤显微手术全切术后ACNU+TMZ+RT组患者1、2、3年Karnofsky≥60所占比率分别为77.4%(24/31)、48.4%(15/31)、22.8%(8/31)。术后1、2年ACNU+TMZ+RT组生存质量明显优于RT组、ACNU+RT组及TMZ+RT组(χ2=8.199,P=0.042)、(χ2=7.864,P=0.049)。结论脑恶性胶质瘤显微手术力争全切除,术后间质内ACNU与TMZ会师化疗同步适形放疗是脑恶性胶质瘤较优化的综合治疗方案,可显著延长患者的生存时间,提高患者的生存质量。

Objective To investigate the effi cacy and safety of rendezvous chemotherapy combined with threedimensional conformal radiotherapy in the treatment for post-operative malignant glioma. Methods A total of 99 patients with full resection of malignant glioma by microsurgery and confi rmed by histopathology were collected. 21 patients were performed three-dimensional conformal radiotherapy alone(RT group), 24 patients received nimustine interstitial chemotherapy combined with RT(ACNU +RT group), 23 patients were treated with temozolomide chemotherapy concurrent combined with RT(TMZ+RT group), and 31 patients received nimustine interstitial chemotherapy rendezvous with temozolomide chemotherapy concurrent combined with RT(ACNU+TMZ+RT group). All patients were followed up for observation of median survival time, 1-, 2-, 3-year survival rates and safety. Results The survival rates of 1-, 2- and 3-year of ACNU+TMZ+RT group were 80.6%(25/31), 48.4%(15/31) and 25.8%(8/31), and the median survival time was 29.0(39.8-18.6) months. The survival time of 1-, 2- and 3-year in ACNU +TMZ+RT group were signifi cantly longer than RT, ACNU +RT and TMZ+RT group(χL 2=21.045, 22.385, P=0.043 and 0.045). The KPS≥60 rates of 1-, 2- and 3-year in ACNU+TMZ+RT group were 77.4%(24/31), 48.4%(15 /31), 22.8%(8/31),respectively. The life quality of 1-, 2-year in ACNU +TMZ+RT group were signifi cantly superior to RT, ACNU +RT and TMZ+RT group(χ2=8.199,P=0.042),(χ2=7.864,P=0.049). Conclusion With full resection of malignant glioma by microsurgery, rendezvous chemotherapy combined with three-dimensional conformal radiotherapy in the treatment for post-operative malignant glioma is the optimum comprehensive treatment plan, which could signifi cantly extend patient's survival time and improve the life quality.