117例高分级脑胶质瘤术后同步放化疗的前瞻性研究

Clinical observation on combined chemo-radiotherapy in high grade intracranial glioma

目的回顾性分析并评价术后同步放化疗治疗高分级脑胶质瘤的疗效。方法 117例高分级脑胶质瘤患者术后随机分为观察组(58例)和对照组(59例)。对照组给予术后常规放疗,总剂量DT=60Gy/6周。观察组化疗与放疗同步进行。在脑部放疗20～30Gy时,口服司莫司汀(Me-CCNU)150mg,放疗期间每周一次,共3～4次,放疗结束后每6～8周一次,共6～8次。结果局部近期疗效观察组和对照组有效率分别为68.97%和25.42%,两者比较差异有统计学意义(P<0.01)。中位复发时间观察组和对照组分为14.25个月和10.38个月(P<0.01)。1、2、3、4年生存率观察组和对照组分别为72.41%、43.10%、22.41%、12.09%和49.15%、15.25%、10.17%、1.69%。经统计分析,2年生存率差异有统计学意义(P<0.05)。观察组急性反应加重,远期损伤两组相近。结论术后同步放化疗能提高高分级脑胶质瘤患者局部控制率,延长复发时间,并可提高生存率。

Objective To evaluate the efficacy of postoperative concurrent radiochemotherapy for high grade intracranial glioma. Methods 117 cases of postoperative intracranial glioma were randomized into observation group （58 cases） and control group （59 cases）. In the control group, routine postoperative external irradiation were administered with a total dose of 60 Gy/6weeks. In the observation group, chemotherapy was concurrently with radiotherapy. When the irradiative dose was 20 to 30 Gy, patients received Me-CCNU 150 mg orally, followed by once every week, the total cycles were three to four during the radiation and the total cycles were six to eight.Results The local response rate of the observation group and control group was 68.97% and 25.42%,respectively. There was significant difference between them（P〈0.01）.Median recurrent time was 14.25 months in the observation group and 10.38 months in the control group（P〈0.01）. The 1-,2-,3-,4 year survival rates were 72.41%,43.10%,22.41%,12.09%, in the observation group and 49.15%,15.25%,10.17%,1.69%, in the control group,respectively. There was statistic significance of the difference between the two groups in 2-year survival rate（P0.05）.The acute toxicity was more serious in the observation group. The late toxicity was approximate in both groups. Conclusion Postoperative concurrent radiochemotherapy is able to improve the local control rate and prolong the recurrent time for the patients with high grade intracranial glioma.It is able to improve survival rate.