三维适形放疗联合替莫唑胺化疗治疗弥漫性脑干胶质瘤

Safety and efficacy of three-dimensional conformal radiotherapy combined with temozolomide in treatment of diffuse bralnstem gliomas

目的研究三维适形放疗（3D—CRT）联合替莫唑胺化疗治疗弥漫性脑干胶质瘤的有效性和安全性。方法对12例弥漫性脑干胶质瘤患者进行3D—CRT，分割方式为1．8Gy／次，1次／d，5次／周，处方剂量为54Gy，总治疗时间为6周。放疗期间每日口服替莫唑胺75mg／m^2，放疗结束后4周，继续给予替莫唑胺标准5d方案辅助化疗6个周期，每个周期28d。第1个周期替莫唑胺用量为150mg／m^2，连用5d，无明显血液学毒性后，从第2个周期始，替莫唑胺剂量增至200mg／m。。对患者进行磁共振成像和实验室检查以评价疗效和不良反应。结果12例弥漫性脑干胶质瘤患者中，完全缓解1例（8．3％），部分缓解6例（50．0％），稳定2例（16．7％），进展3例（25．0％）。全组患者的临床受益率为75．0％，6个月和1年疾病无进展生存率分别为75．0％和50．0％，1年生存率为75．0％。替莫唑胺治疗的不良反应发生率低，以轻度血液学毒性为主。结论替莫唑胺联合同步放疗加后续单药辅助化疗治疗弥漫性脑干胶质瘤有较好的临床疗效，患者能够从中受益。

Objective To study the safety and efficacy of three-dimensional conformal radiotherapy in combination with temozolomide in treatment of patients with diffuse brainstem glioma. Methods Twelve patients with MRI-confirmed diffuse brainstem glioma received 54 Gy three-dimensional conformal radiotherapy for 6 weeks with 1.8 Gy per fraction, 5 times per week. All of the patients were given daily oral temozolomide 75 mg/m2 during radiotherapy. Four weeks after radiotherapy, all of the patients received 6 cycles of temozolomide, each cycle lasted 5 days with 28 days interval between each two cycles. 150 mg/m2 of temozolomide was given for the first cycle for five days, followd by 200 mg/m2 of the drug for the rest of the cycles if no significant drug-related toxicities were observed. Magnetic resonance imaging and laboratory tests were performed to evaluate the efficacy and adverse reactions. Results In the 12 patients, CR was 1 case （8.3%）, PR6 cases （50.0%）, SD 2 cases （16.7%）, and PD 3 cases （25.0%）. The overall clinical benefit rate was 75.0%. Progression-free survival rate was 75.0% （9/12）at 6 months and 50.0% （6/12） at 1 year. The one-year overall survival rate was 75.0%. There were no severe temozolomide-related toxieities. Conclusions Concurrent temozolomide with three-dimensional eonformal radiotherapy and followed by 6 cycles of temozolomide chemotherapy for diffuse brainstem gliomas have a better clinical efficacy, good tolerance and with no severe toxicities.