调强放射治疗联合同步及辅助替莫唑胺化疗治疗脑胶质瘤术后残余病灶的临床研究

Efficacy and safety of intensity-modulated radiotherapy plus concomitant and adjuvant chemotherapy of temozolomide for glioma patients with postoperative tumor residual

目的:观察调强放射治疗(intensity-modulated radiation therapy,IMRT)联合同步及辅助替莫唑胺(temozolomide,TMZ)化疗治疗脑胶质瘤患者术后残余病灶的疗效和不良反应。应用放射治疗剂量学分析IMRT时肿瘤靶区剂量分布及危及器官的受照剂量。方法:研究对象为2008年4月-2009年6月共21例脑胶质瘤术后有残余病灶的患者,其中WHO病理分级Ⅱ级10例,Ⅲ～Ⅳ级11例。IMRT给予肿瘤靶区总剂量59.92～64.20Gy/28～30fx;同步化疗,替莫唑胺每天50～75mg/m2;同期放化疗结束4周后,继续替莫唑胺口服辅助化疗,每天150～200mg/m2d1～5,28d为1个化疗周期,共6个周期。结果:完全缓解2例,部分缓解17例,疾病稳定2例,有效率达90.5;其中Ⅱ级患者的有效率为100.0(10/10),Ⅲ～Ⅳ级患者的有效率为81.8(9/11)。1年无进展生存率为80.9,总生存率为85.7;其中Ⅱ级患者的1年无进展生存率和总生存率均为100.0,Ⅲ～Ⅳ级患者的1年无进展生存率和总生存率分别为72.7和81.8。各重要器官的受照剂量均明显低于常规放疗的最小耐受剂量。不良反应较轻,患者耐受良好。结论:IMRT联合同步及辅助替莫唑胺化疗治疗脑胶质瘤的近期有效率较高且不良反应较轻,可较好地保护肿瘤靶区周围重要的正常器官。

Objective：To observe the efficacy and safty of intensity-modulated radiation therapy（IMRT） plus concomitant and adjuvant chemotherapy of temozolomide（TMZ） for glioma patients with postoperative residual.The target dose distribution and the dose to organs at risk were analyzed by dosiology of radiotherapy.Methods：Twenty-one glioma patients with postoperative tumor residual were enrolled between April 2008 and June 2009,including 10 cases of gradeⅡand 11 cases of grade Ⅲ-Ⅳ within the WHO 2000 classification.All patients received IMRT with a total dosage of 59.92-64.20 Gy/28-30 fx and concomitant chemotherapy（oral TMZ 50-75 mg·m-1·d-1）,followed by 6 cycles of adjuvant TMZ（150-200 mg·m-1·d-1,in a 28-d cycle） 4 weeks after IMRT.Results：There were 2 cases of complete response（CR）,17cases of partial response（PR）,and 2 cases of stable disease（SD）,and the overall response rate（CR＋PR） was 90.5%.The overall response rates of patients with grade Ⅱ and Ⅲ-Ⅳ were 100%（10/10） and 81.8%（9/11）,respectively.The one-year progression-free survival rate was 80.9% and the overall survival rate was 85.7%,which were both 100% in grade Ⅱ,whereas 72.7% and 81.8% in grade Ⅲ-Ⅳ,respectively.The dose of each critical organ in IMRT was obviously lower than the minimum tolerance dose in conventional radiation therapy,and the radiation-related toxicities were mild.All patients in this study could tolerate the regimen.Conclusion：IMRT combined with concomitant and adjuvant TMZ chemotherapy for gliomas has a higher short-term efficacy with less side effects,meanwhile the IMRT for protection of vital organs around the target has certain advantages.