Ⅲ级星形细胞瘤术后放疗联合福莫司汀、长春新碱化疗疗效观察

Effect of postoperative radiotherapy concurrent chemotherapy with fotemustine on grade Ⅲ cerebral astrocytoma

目的:观察术后三维适形放疗联合福莫司汀、长春新碱同步化疗治疗Ⅲ级星形细胞瘤的临床疗效和不良反应。方法:70例Ⅲ级星形细胞瘤部分切除术后患者随机分成2组。A组36例,术后行立体定向适行放疗2～3 Gy/次,1次/d,DT量60～70 Gy。B组34例,放疗方法同A组,并在DT 24 Gy后行同步福莫司汀联合长春新碱化疗,于化疗开始后4～6个月内完成4～6个周期化疗。Kaplan-meier方法计算生存率,Logrank法进行统计分析。结果:1,6,12个月A组有效率分别为44.4%,38.9%,27.8%;B组有效率分别为85.3%,79.4%,70.6%,2组比较差异均有统计学意义(P<0.001)。A组1,2,3年生存率分别为47.2%,22.2%和11.1%;B组分别为88.2%,67.6%和52.9%,2组比较差异有统计学意义(2χ=7.358,P=0.007)。结论:Ⅲ级星形细胞瘤术后放疗联合福莫司汀、长春新碱化疗可提高患者近期有效率和生存率,患者耐受良好。

Objective To study the efficacy and adverse reactions of postoperative stereotactic conformal radiotherapy concurrent chemotherapy with fotemustine on grade Ⅲ cerebral astrocytoma. Methods Seventy postoperative patients with grade Ⅲ cerebral astrocytoma were randomly divided into two groups. Group A（n=36） received postoperative irradiation, 2 to 3 Gy/d, totally DT60 to 70 Gy. Group B（n= 34） received irradiation combined with chemotherapy. Fotemustine and vincristine sulfate were delivered for 4 to 6 cycles within 4 to 6 months after stereotactic conformal radiotherapy. Kaplan-meier method was used to calculate the survival rates, and the logrank method was used to test the significance. Results The 1-, 6-, and 12-month effective rates（CR＋PR） were 44.4%, 38.9% and 27.8% in group A, and were 85.3%, 79.4G and 70.6% in group B, which showed significant differences（P〈0.01）. The 1-, 2 , and 3-year survival rates were 47.2%, 22.2% and 11.1% in group A, and were 88. 20%, 67. 6% and 52. 9% in group B, which showed significant differences （X^2= 7. 358, P = 0. 007）. Conclusion Postoperative concurrent radiochemotherapy can improve the short-term effective rates and the survival rates in patients with grade Ⅲ cerebral astrocytoma. And it is tolerable.