高分级脑胶质瘤术后同步放化疗联合辅助化疗的临床观察

Clinical analysis of concurrent chemo-radiotherapy combined with adjuvant chemotherapy after surgical resection in patients with high-grade glioma

目的：评价应用磁共振成像（magnetic resonance imaging，MRI）模拟定位的术后同步放化疗联合辅助化疗治疗高分级脑胶质瘤术后患者的疗效和不良反应。方法：对2004年12月-2009年儿月在本院肿瘤放射治疗科接受治疗的连续79例Ⅲ～Ⅳ级高分级脑胶质瘤术后患者进行同步放化疗。适形放疗：6MV X线，1．8～2．0Gy／次，1次／d，肿瘤总剂量约为60Gy／30～33次；同步化疗：替莫唑胺75mg／m^2口服，1次／d，直至放疗结束。放疗后1个月开始替莫唑胺辅助化疗（第1个疗程为150mg／m^2，第2个疗程开始为200mg／m^2，1次／d，连续5d，28d为1个疗程）。对所有患者进行随访，采用Kaplan Meier法计算1、3和5年生存率。结果：79例患者的随访率为100％，中位随访时间为44个月（范围：12～60个月），1、3和5年总生存率分别为87．3％、58．5％和37．6％，中位生存期为42个月。COX比例风险模型的预后多因素分析结果显示，年龄（〈48岁与≥48岁比较，P=0．027）、术后肿瘤残留（残留与无残留比较，P=0．020）、病理分级（Ⅲ级与Ⅳ级比较，P=0．023）、放疗剂量（60Gy与〈60Gy比较，P=0．008）和辅助化疗疗程数（1～2个与3～6个比较，P=0．035）是独立的预后因素。同步放化疗的不良反应较轻，均可耐受。结论：MRI模拟定位的适形放疗联合同步化疗及辅助化疗治疗高分级脑胶质瘤术后患者的疗效较好，不良反应可以耐受。

Objective： To investigate the efficacy and safety of concurrent chemo-radiotherapy [magnetic resonance imaging （MRI） simulation localization] combined with adjuvant chemotherapy after surgical resection in patients with high-grade glioma. Methods： Seventy-nine consecutive postoperative patients with grades III-IV glioma received concurrent chemo-radiotherapy in Department of Radiation Oncology, Shanghai Minhang District Cancer Hospital between December 2004 and November 2009. The conformal radiation therapy was performed with a 6 MV X-ray fractionated-dose of 1.8-2.0 Gy and up to a total dose of 60 Gy in 30-33 fractions. The concurrent chemotherapy was administered with temozolomide at a dose of 75 mg/m^2 per day until the end of radiation therapy. One month after radiotherapy, temozolomide was administered 150 mg/m^2 per day for 5 days in the first cycle of adjuvant chemotherapy and 200 mg/m^2 per day for 5 days in the following cycles and repeated every 21 days. The follow-up was conducted in 79 patients. The one-, two-, and three-year survival rates were calculated by Kaplan-Meier method. Results： The rate of follow-up was 100% with a median follow-up of 44 months （range： 12-60）. The one-, two-, and three-year survival rates were 87.3%, 58.5% and 37.6%, respectively. The median survival time was 42 months. The result of COX proportional-hazards regression revealed that the age （≥ 48 years vs 〈 48 years, P = 0.027）, pathological classification （grade III vs grade IV, P = 0.023）, cycles of chemotherapy with temozolomide after radiation （1-2 vs 3-6, P = 0.053）, radiation dose （〈 60 Gy vs 60 Gy, P = 0.008） and residual tumor after operation （yes vs no, P = 0.020） were independent prognostic factors. No severe adverse effects related to radiation therapy and chemotherapy were observed. Conclusion： The conformal radiation therapy using MRI simulation localization combined with concurrent chemotherapy and adjuvant chemotherapy after surgical resection in patients with high-grade glioma seems to have a favorable efficacy and tolerability.