高级别脑胶质瘤患者术后同步放化疗的临床疗效研究

Postoperative concurrent chemoradiotherapy for high-grade cerebral glioma

目的探讨术后不同方案同步放化疗和单纯放疗对高级别脑胶质瘤患者的疗效和安全性的差异。方法海军总医院放射肿瘤科自2004年6月至2008年6月间采用不同方案治疗经病理证实的高级别脑胶质瘤患者59例，均行三维适形放射治疗（3D—CRT），其中联合替荧唑胺fTMZ）化疗患者21例fA组，Ⅲ级13例，Ⅳ级8例），联合尼莫司汀（ACNU）加替尼泊苷（VM－26）化疗患者26例（B组，Ⅲ级14例、Ⅳ级12例），未联合化疗患者12例（C组，Ⅲ级8例，Ⅳ级4例）。分析比较3组患者的疗效、不良反应和生存率。结果A、B组患者的治疗有效率均高于C组，差异有统计学意义（P〈0．05）；B组血液学毒性、消化道副反应的发生率较A组高，差异均有统计学意义（P〈0．05）：全组中位疾病无进展生存时间（PFS）为8个月，中位总生存时间（OS）为15个月，Log—rank检验结果显示3组患者疾病无进展生存率、生存率不同，差异有统计学意义（P〈0．05），A、B组患者的疾病无进展生存率、生存率均高于C组，差异有统计学意义（P〈0．05）。结论高级别腩胶质瘤患者术后同步放化疗效果显著优于单纯放疔，可提高肿瘤治疗有效率及患者的PFS和OS。化疗方案推荐使用TMZ单药化疗，其与ACNU加VM26联合化疗疗效相当，但毒副反应更低。

Objective To study the efficacy and security of postoperative radiotherapy alone and post-operative radiotherapy combined with chemotherapy in patients with high-grade cerebral glioma. Methods Fitly-nine patients with high-grade cerebral glioma confirmed by pathology, including 35 with grade III and 24 with grade IV, admitted to our hospital from June 2004 to June 2008, were chosen in our study; these patients were randomly divided into 3 groups （A, B and C）. All the patients underwent three-dimensional conformal radiation therapy （3D-CRT） with a dose of 54-66Gy/27-33f/5-7w by 6/10MV-X ray; and the median total dose was 60 Gy; group A （n=21, including 13 with grade III and 8 with grade IV） received chemotherapy with temozolomide （TMZ） at a dosage of 75 mg/m^2. d during radiotherapy, following by 150-200 nag/ （m^2.d） for 5 d, and enjoying 28 d per cycle for a total of 3-5 cycles; group B （n=26, including 14 with grade III and 12 with grade IV） received chemotherapy with the regimen ofnimustine （ACNU） with a dosage of 90 mg/m^2 on the 1^st d and teniposide （VM-26） at a dosage of 60 mg/m^2 on the 1^st, 2^nd and 3^rd, enjoying 6-8 weeks per cycle for a total of 4-6 cycles; group C （n=12, including 8 with grade III and 4 with grade IV） received radiotherapy alone. Clinical evaluations of tumor response and adverse effects were performed periodically. The primary end points were disease progression-free survival （PFS） and overall survival （OS） Results The effective rate in the group A, B and C was 81.0%, 71.4% and 33.3%, respectively, indicating that significant differences exited between group C and both group A and B （P〈0.05）. The incidence of gastrointestinal side effects and toxic response in the group B was obviously higher than that in the group A （P〈0.05）. The 1-, 3- and 5-year survival rates in group A were 66.7%, 19.0% and 9.5%, respectively, which were the highest among the 3 groups; those in group B were 53.8%, 15.4% and 3.8%, respectively; those in group C were 25%, 8% and 0%, respectively. The PFS in all the patients was 8 months and OS was 15 months; log-rank test indicated that significant differences of PFS and OS existed between patients received concomitant chemoradiotherapy and radiotherapy （X^2=10.710, P=0.005; X^2=7.185, P=-0.028）; the incidence of PFS and OS in group A and B was significantly higher than that in group C （P〈0.05）. Conclusion To post-operative patients with high-grade cerebral glioma, concomitant chemoradiotherapy can improve the effective rate and extend the PFS and OS. TMZ is recommended as the concomitant chemotherapy regimen, having similar therapy effect with ACNU plus VM-26, but enjoying less adverse effects.