脑胶质瘤治疗中常见缺陷原因分析

Analysis of Reasons of Suboptimal Adjuvant Therapies in Glioma Patients

背景与目的:目前国内还没有一个统一的胶质瘤治疗规范。临床经常见到各种治疗上存在缺陷的脑胶质瘤患者,其生存期和生存质量较差。本文旨在分析总结脑胶质瘤患者治疗中存在的缺陷及其原因,为临床治疗提供参考。方法:收集自2000年1月至2006年3月期间在中山大学肿瘤防治中心门诊及住院诊治的有完整病案记录、有完整随访资料和有明确病理诊断的脑胶质瘤患者的资料。参照2005年美国NCCN(NationalCompressiveCancerNetwork)的诊疗规范,以及中山大学肿瘤防治中心脑胶质瘤单病种诊疗指引(2006),共收集82例治疗有缺陷的胶质瘤患者的资料,用Kaplan-Meier法来评估患者术后的生存状况,同时分析造成治疗缺陷的原因。结果:低级别胶质瘤中位无疾病进展生存时间为33个月,高级别胶质瘤中位无疾病进展生存时间为13个月;低级别胶质瘤中位生存时间为42个月,高级别胶质瘤中位生存时间为23个月。各种治疗缺陷的胶质瘤患者治疗后KPS评分明显下降。各种治疗缺陷以因患者原因导致手术后需要而未行放化疗的患者最多,共24例,占29.3%;其次为因医生原因导致的应该而未行化疗的患者,共18例,占22.0%;然后为因医生原因导致手术后需要而未行放化疗者、术后未行普通放疗而先行γ-刀治疗及因患者原因术后化疗而未行放疗者,各7例,分别占8.5%。结论:目前在脑胶质瘤的临床实践中有众多胶质瘤患者治疗存在缺陷,其中主要是因医生或/和患者原因导致的手术后应该而未行常规放疗及系统化疗的患者。所以在神经肿瘤医生中强调对胶质瘤的规范治疗意识十分迫切。

BACKGROUND ＆ OBJECTIVE： Threre are no national guidline for glioma treatment in China's Mainland yet, and thus inappropriate managements for patients with gliomes were not uncommon. This article was to analyze and to summarize the progress free survival （PFS） and the reasons of suboptimal adjuvant therapies in patients with gliomas without standard adjuvant therapies. METHODS： Data of 82 patients treated without standard adjuvant therapy were reviewed and analyzed according to NCCN （National Comprehensive Cancer Network） guideline （2005） as well as Cancer Center of Sun Yat-sen University Guideline （2006）. Kaplan-Meier method was used to evaluate progress free survival and overall survival. The reasons of suboptimal treatment were recorded. RESULTS： The median progression-free survival （PFS） was 33 months in patients with low grade glioma and 13 months in patients with high-grade gliomas. The median overall survival was 42 months in patients with low grade glioma and 23 months in patients with high-grade gliomas. The Karnofsky Perfonnanee Status （KPS） was mueh lower in the patients with suboptimal adjuvant therapies. In patients with suboptimal therapies, 24 patients defaulted radiotherapy and chemotherapy after operation （29.3%）. Seven patients defaulted chemotherapy （8.5%）. Eighteen patients were not referred to for chemotherapy （22.0%）. Seven patients were not referred to for radiotherapy and chemotherapy after operation （8.5%）. Seven patients received gamma knife（9.8%） instead of conventional radiotherapy. CONCLUSIONS ： In clinical practice, some patients with gliomas were not provided with standard adjuvant therapies. A systematic referral system and a comprehensive muhi-modalities treatment is essential for glioma patients.