替莫唑胺联合放射治疗治疗恶性脑胶质瘤的疗效观察

The efficacy of Temozolomide combined with radiotherapy for treatment of malignant gliomas

目的探讨替莫唑胺（TMZ）联合放射治疗治疗恶性脑胶质瘤的临床疗效和安全性评价。方法收集56例病理学诊断为恶性脑胶质瘤的患者,其中III级患者为32例,IV级患者为24例。根据不同的治疗方法将患者分为TMZ联合放疗（TMZ-RT）组（30例）和单纯放疗（RT）组（26例）。TMZ-RT组患者采用放疗联合TMZ化疗（75 mg·m^-2·d^-1）治疗6周,放疗后继续给予TMZ序贯/辅助（150-200 mg·m^-2·d^-1）化疗2-4周。RT组患者接受立体定向适形放射治疗1.8~3Gy/d,部分患者接受超分割放射治疗,总剂量为60-75 Gy。治疗结束后评估两组患者的生存率和近期疗效。结果影像学结果显示,TMZ-RT组完全缓解8例,部分缓解9例,稳定10例,进展3例;RT组完全缓解6例,部分缓解8例,稳定8例,进展4例,两组差异无统计学意义（P〉0.05）。TMZ-RT组患者的1、2、3年生存率分别为86.7%、80.0%和56.7%。RT组患者的1、2、3年生存率分别为73.1%、30.8%和11.5%,两组患者的2年和3年生存率比较,差异有统计学意义（P〈0.05）。TMZRT组和RT组患者的中位复发时间分别为（23.1±8.7）个月和（15.8±8.9）个月,两组差异有统计学意义（P〈0.05）。TMZ-RT组和RT组患者化疗后KPS评分别为（89.8±9.7）分和（65.4±10.3）分,两组间差异有统计学意义（P〈0.05）。TMZ-RT组患者的不良反应发生率较低且,患者的生活质量水平显著高于RT组患者（P〈0.05）。结论 TMZ联合放疗与单纯放疗治疗恶性脑胶质瘤的近期疗效相当,但TMZ联合放疗能够显著提高2年和3年的生存率并延缓复发时间。TMZ联合放疗治疗不良反应轻,安全性高,能够改善患者的生活质量,值得临床进一步推广。

Objective To explore the efficacy of Temozolomide （TMZ） combined with radiotherapy for treatment of malignant gliomas. Methods A total of 56 malignant gliomas patients who were diagnosed by pathology （32 cased of grade Ⅲ and 24 cases of grade IV） were divided into TMZ-RT （temozolomide combined with radiotherapy） group and RT （radiotherapy） group. Patients of TMZ-RT group （30 cases） were given the therapy of TMZ （75 mg · m^ -2 · d^-1 ） combined with 3D-CRT, while the patients of RT group only received the 3D-CRT therapy. The efficacy, survival rate, median recurrent time, life quality and safety of the two groups were evaluated and compared. Results There was no statistically significant difference of the short-term curative effect between the two groups （P 〉0. 05）. The 1-,2-,3- year survival rates of the patients in the TMZ-RT group were 86.7%, 80. 0% and 56. 7%, which are higher than those of RT group （73. 1%, 30. 8% and 11.5% ）. Median recurrent time of the two groups was （23.1± 8.7） months and （ 15. 8 ± 8.9） months, respectively. There was significant differences in 2-,3-year survival rates and median recurrent time between the two groups （ P 〈 0. 05 ）. The adverse reaction of the TMZ is so slight that don＇t affect the treatment. The improvement of life quality in TMZ-RT group was significantly better thanthat of the RT group. Conclusion TMZ combined with radiotherapy is effective and safe for treatment of malignant gliomas. It is worthy of clinical promotion.