恶性胶质瘤术后放疗联合化疗预后分析

目的探讨恶性胶质瘤显微外科手术后的治疗方法。方法对41例恶性胶质瘤患者随机分为微外科手术后放疗（对照组）和放疗联合化疗（观察组）两组，对照组（n=21）在显微外科手术后给予常规放疗，即总剂量DT60Gy／6周；观察组（n=20）在显微外科手术后放疗联合化疗（化疗药他莫昔芬），化疗在放疗结束后1个月开始，每日口服他莫昔芬60mg、连续服用6个月。随访5年。结果近期疗效对照组23．81％，观察组75．0％；复发时间对照组12．5个月，观察组17个月；对照组和观察组患者1、2、3、4、5年生存率分别为57．14％与75％、23．81％与60％、19．05％与50％、14．29％与30％、9．52％与20％，其中2年和3年生存率差异有统计学意义（P〈0．05）。此外，他莫昔芬化疗患者仅出现轻微头晕，未发现共济失调、深静脉栓塞和肺栓塞等严重并发症。结论显微外科术后放疗联合他莫昔芬化疗较传统放疗能提高恶性胶质瘤患者近期有效率、延长肿瘤复发时间，延长生存期，且无明显的毒副作用，为临床治疗恶性胶质瘤提供了新的治疗策略，有可能成为一线治疗方法。

Objective To explore the efficacy and side effects on microsurgery synchronous radiotherapy combined with tamoxifen chemotherapy in malignant glioma. Methods Forty-one patients with malignant glioma were randomly divided into control group （ n=21 ） and observation group （ n=20 ） . Control group was given routine radiotherapy microsurgical postoperatively with a total dose of 60 Gy/6weeks. Observation group was given synchronous radiotherapy combined with chemotherapy, after radiotherapy given 60 mg/d tamoxifen for 6 months, and then followed for 5 years. Results Compared with the control group, local recent curative effect of observation group was obviously higher （ 23.81% VS. 75% ） , the median time to relapse was also significantly extended （ 12.5months VS. 17months ） （ P〈0.05 ） . Followed for 5 years, it found that 1, 2, 3, 4, 5 years of survival rate were 57.14% and 75%, 23.81% and 60%, 19.05% and 50%, 14.29% and 30%, 9.52% and 20% in the control group and observation group respectively. And 2 years and 3 years survival rate were statistically different （ io〈0.05 ） . Except for mild dizziness, deep vein thrombosis, pulmonary embolism and ataxia were not found in in tamoxifen treatment group. Conclusion Compared with traditional radiation therapy, microsurgery synchronous radiotherapy combined with tamoxifen chemotherapy in malignant glioma can significantly improved local recent effective rate, extend the time of tumor recurrence, and increase survival rate, bring no obvious side effects, which provides a new treatment strategy for clinical treatment of malignant glioma.