脑胶质瘤术后超选介入化疗联合系统化疗的临床研究

Super-selective interventional chemotherapy combined with systemic chemotherapy for the treatment of postoperative gliomas:a clinical study

目的探讨术后超选择介入化疗联合系统化疗治疗脑胶质瘤的优势。方法 2006年至2009年山东济宁市第一人民医院介入科收治46例脑胶质瘤的患者,据患者自愿入组的原则分为两组。治疗组:25例患者手术后先行常规放疗,然后行超选介入化疗,同期进行系统化疗。对照组:21例患者手术后先行常规放疗,然后只进行系统化疗。定期随访,复查颅脑CT,测量肿瘤的体积,并进行Karnofsky预后评分。比较肿瘤体积变化及两组间Karnofsky预后评分的差异。结果平均随访2.3年,两组均无死亡病例。化疗前两组肿瘤的体积差异无统计学意义,(P>0.05)。化疗1年后介入化疗联合系统化疗组肿瘤缩小率为67.11%,系统化疗组肿瘤缩小率为45.79%,两组肿瘤体积经独立样本t检验显示肿瘤体积差异有统计学意义(P<0.05)。治疗组在化疗期间出现癫痫3例,眼痛5例,头痛9例,恶心呕吐8例,血小板下降1例。对照组出现癫痫1例,头痛7例,血小板下降3例,恶心呕吐6例。Wilcoxon秩和检验Karnofsky预后评分显示介入化疗结合系统化疗组的预后优于单纯系统化疗组。(P<0.05)。结论术后放疗结合介入化疗联合系统化疗的治疗方法,与术后放疗结合系统化疗的治疗方法相比,可以更有效的控制肿瘤的生长,改善临床症状,提高生活质量,是值得进一步探讨的化疗方法。

Objective To evaluate super-selective interventional chemotherapy combined with systemic chemotherapy in treating postoperative gliomas.Methods During the period of 2005-2009,a total of 46 patients with glioma were encountered in our hospital.According to the principle of patient＇s free will the involved patients were divided into two groups.Study froup（n = 25）：after operation the patients received routine radiotherapy,which was followed by super-selective interventional chemotherapy combined simultaneously with systemic chemotherapy.Control group（n = 21）：after operation the patients received routine radiotherapy,which was followed by systemic chemotherapy only.The patients were regularly followed up.Cranial CT checkups were made to determine the tumor size,and the results were evaluated with Karnofsky scores.The clinical data were analyzed and compared between two groups.Results In the study group,the side-effects and complications included epileptic seizures（n = 3）,eye pain（n = 5）,headache（n = 9）,nausea and vomiting（n = 8） and thrombopenia（n = 1）.In the control group,the side-effects and complications were as follows：epileptic seizures（n = 1）,headache（n = 7）,nausea and vomiting（n = 6） and thrombopenia（n = 3）.No death occurred in either of the two groups.The patients were followed up for an average period of 2.3 years.Before chemotherapy no statistically significant difference in tumor size existed between two groups（P 0.05）.One year after the chemotherapy,the tumor volume in study group was reduced by 67.11%,while it was 45.79% in control group.By using independent sample t test analysis,the difference between two groups was of statistical significance（P 0.05）.Wilcoxon rank sum test and Karnofsky prognostic score analysis indicated that the prognosis of study group was much better than that of control group（P 0.05）.Conclusion In comparison with routine radiotherapy plus simple systemic chemotherapy,routine radiotherapy plus superselective interventional chemotherapy as well as systemic chemotherapy can more effectively inhibit tumor growth,relieve clinical symptoms and improve living quality.Therefore,it is of clinical value to make a further study of this technique.