三维适形放疗联合替莫唑胺治疗恶性脑胶质瘤的临床观察

Clinical observation in Temozolomide combined with radiotherapy in treatment of postoperative malignant glioma

目的：比较三维适形放疗联合替莫唑胺（temozolomide，TMZ）和单纯适形放疗治疗恶性脑胶质瘤的疗效和安全性。方法：选择2003～2007年收治的41例术后病理确诊的恶性胶质瘤患者，随机分为试验组18例和对照组23例。试验组在适形放疗同时采用TMZ化疗6个周期；对照组仅行适形放疗。结果：试验组CR为22．22％（4／18），PR为44．44％（8／18），有效率为66．67％；对照组CR为13．04％（3／23），PR为21．74％（5／23），有效率为34．78％；两组比较差异有统计学意义，P=0．044。试验组1、2、3年生存率分别为94．44％、83．33％和61．11％，对照组分别为60．87％、47．83％和30．43％；试验组中位复发时间为21个月，对照组中住复发时间为17个月。1、2、3年生存率及中住复发时间两组比较，差异均有统计学意义，P值分别为0．036、0．021、0．049和0．041。结论：适形放疗联合TMZ治疗脑胶质瘤的效果好于单纯放疗，不良反应无明显增加。

OBJECTIVE： To compare the efficiency and safety of temozolomide administered concomitantly and adjuvantly to three di mensional conformal radiotherapy versus three dimensional conformal radiotherapy alone in patients with postoperative malignant glioma. METHODS：Forty one postoperative patients with pathologically confirmed malignant glioma were randomly assigned to receive Temozolomide, concomitantly with three dimensional conformal radiotherapy （experiment group,n= 18）, followed by six cycles of temozolomide,or three dimensional conformal radiotherapy alone （control group, n = 23）. RESULTS： The overall response rates（CR＋PR） were 66.67% in experiment group, including 4 （22.22%）patients with complete responses and 8（44.44%）partial responses, and 34.78% in the control group, including 3（13.04%） patients with complete responses and 5 （21.74%） partial responses, and with significant difference between the2 groups,P=0.044. The 1-,2-,and 3- year survival rates of patients in the experiment group were 94.44 %, 83.33%, 61. 11%, and 60.87%, 47.83%, 30. 43% in the control group. The median recurrent period in the experiment group were 21 months and 17 months in the control group, and with singnificant difference, and P were 0. 036, 0. 021, 0. 049 and 0. 041 respectively. CONCLUSION： Three dimensional conformal radiotherapy with temozolomide seems to be more ef- fective than radiotherapy alone in malignant glioma, and no more adverse effect.