恶性脑胶质瘤MGMT活性高患者的化疗方案探讨

Chemotherapy against malignant glioma with high MGMT expression

目的探讨脑胶质瘤（Ⅲ～Ⅳ级）06_甲基鸟嘌呤一DNA甲基转移酶（MGMT）高活性的患者对烷化剂耐药时选择MGMT抑制剂与烷化剂联合应用的化疗方案。方法32例脑恶性胶质瘤患者作为治疗组，MGMT检测活性在（＋＋）以上，于术后2周通过动脉介入技术，先注入链脲菌素（STZ）2g／M。，2h后注入盐酸尼莫司汀（宁得朗）2～3mg／kg，1次／月，3次为1疗程。93例脑恶性胶质瘤，MGMT检测（一）作为治疗对照组，治疗方法同上，但仅用盐酸尼莫司汀（宁得朗）治疗。结果两组患者分别在注药后3、6、9次行MRI增强扫描，随访时间3个月～3年，分别获得不同时间段肿瘤复发率及病死率数据。两组比较差异无统计学意义（P〉0．05）。结论对于MGMT活性高且对烷化剂耐药的患者，应用MGMT抑制剂链脲菌素可以降低肿瘤的耐药性，使常用的脑胶质瘤化疗药烷化剂发挥其有效的抗肿瘤作用，为脑恶性胶质瘤对烷化剂耐药的病例有针对性的个体化化疗提供可靠和有效的：疗法。

Objective To study the chemotherapy of 06-methylguanine-DNA methyltransferase （MGMT） inhibitor combined with alkylating agents against glioma （ WHO m - 1v ） with high MGMT expression. Methods Trial group, including 32 malignant glio- ma patients with MGMT over （ ＋ ＋ ） , was treated with interventional chemotherapy two weeks after surgery. Streptozotoein （STZ） was injected at a dose of 2 g/M2 followed by 2 - 3 mg/kg Nimustine after 2 hours. Drugs were injected once a month （three times regarded as one course）. Control group, including 93 patients with MGMT （ - ） , was treated with 2 -3 mg/kg Nimustine alone. Results All the patients were performed Gd-enhanced MRI after 3,6,9 times＇ administration of therapy and followed up for 3 months to 3 years. Recurrence and mortality were obtained. No significant difference was found between the two groups. Conclusion For the patients with high MGMT expression, STZ, a MGMT inhibitor, may reduce the drug resistance of tumor, in order to reha- bilitate the anti-cancer effects of alkylating agents. The use of STZ may induce a reliable and effective method to the individual chemotherapy for the patients with alkylating agent resistance.