Ⅲ、Ⅳ级脑胶质瘤术后调强放疗联合替莫唑胺化疗的临床研究

Clinical research of intensity-modulated radiotherapy concurrent with Temozolomide in patients with postoperative high-grade gliomas

目的评价Ⅲ、Ⅳ级脑胶质瘤术后调强放疗同步替莫唑胺化疗的疗效和毒副反应。方法回顾性分析我科2006年1月至2009年1月22例Ⅲ、Ⅳ级脑胶质瘤术后患者资料,所有患者采用调强放疗同步整合加量技术,处方剂量为PGTV 60Gy/25次,2.4Gy/次;PCTV 50Gy/25次,2.0Gy/次。其中有9例患者在放疗开始时口服替莫唑胺,剂量为150mg·m-2·d-1,连服5天,每4周为1个周期,最多连续服用6个周期。结果全组1、2年总生存率是68.8%、56%。平均生存时间12.1个月。单因素分析结果显示病理分级(χ2=15.232,P=0.000)和化疗(χ2=7.128,P=0.008)是影响预后的因素。多因素分析结果显示病理分级(P=0.002)是影响预后的独立因素。结论调强放疗同步整合加量技术同步替莫唑胺化疗是安全有效的,生存结果同历史对照相似。更确切的疗效需扩大病例数进一步研究。

Objective To evaluate the treatment of intensity-modulated radiotherapy concurrent with temozolomide and adverse effect for postoperative high-grade gliomas.Methods To retrospectively analyze the data of 22 consecutive patients（WHO grade Ⅲ,16 patients;WHO grade IV,6 patients） in our department.All patients were performed by simultaneous integrated boost intensity-modulated radiotherapy.The prescribed dose was delivered to the planning target volume with 60Gy/25f,2.4Gy/f and the clinical target volume with 50Gy/25f,2.0Gy/f.Among them,nine patients were taken temozolomide from initial radiation with dose of 150mg·m-2·d-1,d1-d5.Every 4 weeks as one cycle,less than 6 cycles.Results One-and two-year survival rates were 68.8% and 56%,retrospectively.Median survival was 12.1 months.Univariate analysis represented that pathology（χ2=15.232,P=0.000） and chemotherapy（χ2=7.128,P=0.008） were related with prognosis.While Cox regression model showed that only pathology（χ2=0.002） was the independent prognostic factor.Conclusion Intensity-modulated radiotherapy concurrent with temozolomide is safe and feasible,with a survival result approach to the history control,although further investigation is warranted to test its survival advantage.