替莫唑胺联合适形调强放射治疗MGMT阳性的高级别脑胶质瘤临床疗效观察

The clinical observation of temozolomide combined with intensity-modulated radiotherapy in the treatment of malignant glioma with positive MGMT

目的:探讨6-氧-甲基鸟嘌呤DNA甲基转移酶(MGMT)阳性表达的患者应用替莫唑胺联合适形调强放疗(IMRT)的疗效。方法:采用免疫组织化学检测MGMT阳性表达的Ⅲ～Ⅳ级脑胶质瘤患者34例(包括间变性星形细胞瘤13例,间变性少枝细胞瘤11例,胶质母细胞瘤10例),分为替莫唑胺联合IMRT同步治疗组(治疗组)15例,单纯IMRT组(对照组)19例。2组均行头颅IMRT 95%计划靶区60 Gy/30f/42 d,治疗组在放疗同时口服替莫唑胺75 mg/m2,每周5 d,共6周,放疗结束后4周再接受4～6疗程化疗,150～200 mg/m2,连服5 d,28 d为一疗程。结果:治疗组客观有效率为46.67%,疾病控制率为86.67%,对照组分别为42.11%和84.21%;中位生存时间治疗组1.5年,对照组1.3年;1年生存率治疗组为60%,对照组为57.89%,2组结果差异均无统计学意义(P>0.05)。结论:替莫唑胺联合IMRT同步治疗MGMT阳性的高级别脑胶质瘤的疗效不优于单纯IMRT。

Objective： To explore the effects of temozolomide （TMZ） combined with intensity-modulated radiotherapy （IMRT） on gliomas with postive 06-methylguanine-DNAmethyltransferase （MGMT）. Methods： Thirty-four cases （ including 13 cases anaplastic astrocytomas, 11 cases anaplastic oligodendrogliomas and 10 cases glioblastomas multiforme） with Ⅲ - Ⅳ grade of MGMT-positive malignant gliomas diagnosed by immunohistochemical method were divided into treatment group （ 15 cases ） and control group （ 19 cases）. The control group were treated with 95% PTV 60Gy/30f/42d in the head IMRT, and 75 mg/m^2 of TMZ was added in the treatment group for 6 weeks （5 days, each week）. The treatment group were treated with chemotherapy for 4 to 6 courses within 4 weeks after completing radiotherapy, 150 - 200 mg/m^2 was given for 5 days （ 28 days, each course ）. Results ： The objective effective and disease control rate of the treatment and control group were 46.67% ＆ 86.67% and 42.11% ＆ 84.21% ,respectively. The median survival time of the treatment and control group were 1.5 and 1.3 years, respectively. The one-year survival rate of the treatment and control group were 60% and 57.89%, respectively. There was not statistical significance between two groups （P 〉 0.05 ）. Conclusions： The effects of TMZ combined with IMRT in the treatment of MGMT-positive malignant gliomas are better than that of IMRT alone.