成人Ⅱ级以上脑胶质瘤术后同步放化疗疗效分析

Effect of Postoperative Radiotherapy Concurrent Chemotherapy on Adult Patients with Grade Ⅱ～Ⅳ Cerebral Gliomas

目的前瞻性研究成人Ⅱ级以上脑胶质瘤患者术后同步放化疗的疗效。方法1999年9月～2003年5月收治80例成人Ⅱ级以上脑胶质瘤术后患者,随机分成两组,各40例。①单纯放疗组,行单纯放疗,DT50～60Gy;②同步放化疗组,给予与单纯放疗组相同的放疗方法,同时于DT20Gy后行同步替尼泊甙(VM-26)联合司莫司汀(Me-CCNU)化疗,于放疗开始后4～6个月内完成4～6周期化疗。结果术后同步放化疗组1、3、5年生存率分别为85.00%、52.50%、30.00%,优于术后单纯放疗组的62.50%、27.50%、15.00%(χ2=5.07,P=0.024)。按不同病理分级进行比较,Ⅲ级脑胶质瘤同步放化疗的生存率明显优于单纯放疗(χ2=3.96,P=0.047),而Ⅱ级和Ⅳ级脑胶质瘤上述两种疗法的生存率无差异。结论成人Ⅲ级脑胶质瘤患者术后外照射20Gy后行同步MV方案化疗,预后优于术后单纯放疗;对于Ⅳ级脑胶质瘤患者,其术后化疗方法以及放化疗结合方式仍需要探讨;成人Ⅱ级脑胶质瘤术后可以不必给予放化疗联合治疗。

Objective To prospectively study the survival of adult patients with grade Ⅱ-Ⅳ cerebral gliomas received radiochemotherapy postoperatively. Methods From sept. 1999 to may 2003, 80 adult postoperative patients with grade Ⅱ-Ⅳ cerebral gliomass were treated and divided into two groups randomly, each had 40 eases. One group（RT group） was irradiated with DT50-60 Gy merely and the other （RCT group） combined with chemotherapy（VM-26 and Me-CCNU） after DT20 Gy and 4-6 cycles of chemotherapy were delivered within 4 -6 months. Results The 1-, 3-, and 5- year survival rate of patients of RCT group was 85. 00%.52. 50%. 30. 00% while the survival rate of RT group was 62.50% .27. 50%. 15.00%, respectively. The difference of the survival rates between two groups was significant（χ^2= 5. 07, P = 0. 024）. Based on pathological grades, however, it was suggested that only the patients with grade Ⅲ gliomas of RCT group had better prognosis than ones of RT group （χ^2 = 3.96, P = 0. 047）. The similar results were not found in patients with grade Ⅱ or Ⅳ gliomas. Conclusion Given concurrent radiochemotherapy postoperatively, the survival could be improved in adult patients with grade Ⅲ gliomas. And the data suggested that VM-26 combined with Me-CCNU should be an effective chemotherapeutic scheme. AS to grade Ⅳ gliomas, more novel chemotherapeutic methods shoud be studied. The patients with grade Ⅱ gliomas needn＇t receive chemotherapy besides postoperative radiotherapy.