恶性脑胶质瘤术后三维适形放射治疗

Clinical analysis of postoperative 3-dimensional conformal radiotherapy for malignant gliomas

目的探讨恶性脑胶质瘤术后三维适形放射治疗(3DCRT)的临床疗效及患者不良反应。方法将62例恶性脑胶质瘤术后患者随机分为两组,3DCRT 组32例,常规放疗组30例,照射剂量均为D_T 60 Gy/30次,6周。结果 3DCRT 组近期有效(CR+PR)率为87.5%(28/32),常规放疗组为73.3%(22/30),两组比较差异无统计学意义(P=0.158)。3DCRT 组1、2年生存率分别为90.6%(29/32)、81.3%(26/32),常规放疗组1、2年生存率分别为80%(24/30)、56.7%(17/30),两组间差异有统计学意义(P<0.05)。3DCRT 组放射性脑水肿发生率为15.6%(5/32),常规放疗组为40%(12/30),两组间差异有统计学意义(P<0.05)。放射性脑水肿经脱水治疗后好转,未发生严重并发症。主要死因是局部未控和肿瘤复发。结论恶性脑胶质瘤术后行3DCRT 比常规放疗有较好的疗效,其有较高的肿瘤局部控制率和1、2年生存率,无严重不良反应。

Objective To determine short-term therapeutic efficacy and side effect of postoperative 3-dimensional conformal radiotherapy for malignant glioma.Methods From January 2003 to January 2005, 62 patients with malignant glioma postoperation were randomized into two groups,32 entered in 3DCRT group and 30 entered in ordinary radiotherapy group.The dose of radiotherapy was 60 Gy/30 f, 6 weeks. Results The overall response rate in the 3DCRT group was 87.5 %(28/32),in the ordinary radiotherapy group was 73.3 %(22/30).There were no statistical significance(P=0.158).The survival rates at 1-,2-year were 90.6 % (29/32),81.3 %(26/32)in the 3DCRT group and 80 %(24/30),56.7 %(17/30)in the ordinary radiotherapy group. The difference was significant(P<0.05). The incidence of brain edema in the 3DCRT group was 15.6%(5/32),in the ordinary radiotherapy group was 40 %(12/30). The difference was significant(P<0.05). Brain edema were improved after dehydration therapy.No serious syndrome occurred. Primary dead causes were that local control defeated and tumor relapsed.Conclusion 3DCRT is more effective in the treatment for malignant glioma postoperation than ordinary radiotherapy.It has a high local control rate and 1-,2-year survival rate without serious side effect.