紫杉醇与替尼泊苷联合化疗治疗脑恶性胶质瘤

Paclitaxel and Teniposide Combination Chemotherapy for Patients with Malignant Astrocytic Brain Tumors

目的评价紫杉醇与替尼泊苷联合化疗方案对恶性脑神经胶质瘤的治疗效果和毒副作用，探讨有效的辅助化疗方案，以提高恶性脑神经胶质瘤的疗效，延长患者的生存期。方法不能手术、术后残留或复发的恶性脑神经胶质瘤患者，随机分为两组，试验组（21例）：紫杉醇135mg／m^2，静脉滴注，第1天；替尼泊苷200mg／m^2，分3d（d1—3），静脉滴注，3周可重复；对照组（19例）：司莫司汀100mg／m^2，第1天，晚顿服；替尼泊苷用法同前，4～6周可重复。第1周期化疗后常规局部外放疗，肿瘤组织量50-60Gy。结果40例患者有效28例，总有效率70．0％；其中大脑半球胶质瘤有效率65．5％（19／29），脑干胶质瘤有效率88．9％（8／9），小脑胶质瘤有效率50％（1／2）。经X^2检验，两种化疗方案有效率差异无显著性。主要毒性为骨髓抑制，特别是中性粒细胞减少；其中Ⅲ、Ⅳ度毒性反应5例，占12．5％；经对症处理均恢复正常。远期疗效正在观察中。结论紫杉醇与替尼泊苷联合化疗治疗恶性脑胶质瘤安全、有效，为脑瘤辅助化疗提供了新方案。

Objective This study was designed to evaluate the efficacy and toxicity of paclitaxel and teniposide combination chemotherapy on malignant astrocytic brain tumors. Effective adjuvant chemotherapy regimens were also investigated. Methods Patients with malignant astrocytic brain tumors that could not be cured with operation or were recrudescent diseases after operation, were randomized to divided into two groups. The chemotherapy regimen was TV（paclitaxel and teniposide）for the experimental group and MV（semustine and teniposide）for the control group. The patients also received routine radiotherapy after the first cycle of chemotherapy. The efficacy and toxicity were observed in these patients. Results Among 40 cases, 21 patients belonged to TV group and 19 patients belonged to MV group. Twenty eight patients showed effectiveness, with a 70% total effective rate. The effective rates of cerebral hemisphere, brain stem and cerebellum astrocytomas were 65. 5%（19/29）, 88. 9% （8/9） and 50%（1/2）, respectively. The dose-limiting toxicity was bone marrow suppression, especially granulocytopenia. Conclusion It is a safe and effective way to cure malignant astrocytic brain tumors by using TV or MV combination chemotherapy regimen.