放化疗治疗脑胶质母细胞瘤术后残留临床观察

Clinical Research of Simultaneous Integrated Boost Intensity- Modulated Radiotherapy Combined with Temozolomide in Treatment of Postoperativeresidual Glioblastoma

目的研究同步加量调强放疗(SIB-IMRT)联合替莫唑胺化疗治疗脑胶质母细胞瘤术后残留的临床效果。方法对56例脑胶质母细胞瘤术后残留患者行SIB-IMRT,靶区勾画:残留病灶勾画为GTV,外放5 mm为临床靶区(CTV),CTV外放5 mm为计划靶区(PTV);瘤床勾画为临床靶区(CTV1),CTV1分别外放15 mm和30 mm为计划靶区1(PTV1)和计划靶区2(PTV2),PTV、PTV1、PTV2处方量分别为2.5 Gy/次、2.3 Gy/次、2.0 Gy/次,5次/周,共25次;放疗期间每日口服替莫唑胺75 mg/m2。同步放化疗结束后,继续给予替莫唑胺150 mg/m2,连续口服5 d,28 d为1个周期,辅助化疗共6个周期。56例患者单纯行同步放化疗者26例为A组,放化疗结束后继续化疗6个周期者30例为B组。结果全组56例患者中CR 7例(12.5%),PR 38例(67.8%),SD 8例(14.3%),PD 3例(5.4%);全组患者的有效率80.3%。全组平均生存时间为(29.82±9.11)月;1年、2年、3年生存率分别为96.4%、73.2%、33.9%;A组与B组比较平均生存时间、生存曲线差异均有统计学意义(Ρ﹤0.001)。放化疗的不良反应较轻,毒性反应以血液学毒性为主。结论同步加量调强放疗联合替莫唑胺化疗加后续单药辅助化疗治疗脑胶质母细胞瘤术后残留患者有较好的临床效果,不良反应可耐受,建议临床推广应用。

Objective To study the clinical efficacy of simultaneous integrated boost intensity - modulated radiother apy （ SIB - IMRT） combined with temozolomide in treatment of patients with postoperativeresidual glioblastoma. Methods Fif ty six patients with postoperativeresidual glioblastomaof brain received SIB - IMRT. The postoperative residual lesion was de fined as gross tumor volume（GTV）. The margin of GTV expanded 5 mm was defined as CTV. The margin of CTV expanded 5 mm was defined as PTV . The postoperative resectional cavity was defined as CTV1. The margins of CTV1 which were enlarged 15 mm and 30 mm were defined as PTV1 and PTV2 respectively. Doses of 2.5 Gy/f, 2.3Gy/f and 2.0 Gy/f were prescribed for PTV, PTV1 and PTV2 respectively. All patients received irradiation for 5 weeks 5 times per week. All patients were given temozolonlide 75 mg/m： oral daily during radiotherapy. Four weeks after radiotherapy there were 26 patients （ defined as group A） did not continue to take temozolomide. The other 30 patients （ defined as group B） received 6 cycles of temozolomide, each cycle lasted 5 days with 28 days interval between two cycles. Results In the 56 patients, CR was 7 cases（ 12.5 % ）, PR was 38 cases（67.8% ） ,SD was 8 cases（ 14.3% ） ,PD was 3 cases （5.4%）. The responed cases were 45 （80.3%）. The median survival time in all patients, group A and group B was 30 months,23 months and 36 months respectively. The mean survival time was （29.82 ±9.11 ） months in all patients. The overall survival rates of one - , two - and three - year were 96.4% , 73.2% , and 33.9% respectively. The mean survival time and survival curve in group A were significantly lower than that in group B （ P 〈 0.05 ）. There were no severe radiochemotherapy - related toxicities. Conclusion Concurrent SIB - IMRT with temozolomide and followed by 6 cycles of temozolomide chemotherapy for postoperativeresidual glioblastoma has a better elini caloutcome, good tolerance and no severe radiochemotherapyrelated toxicities.