高级别胶质瘤同步放化疗中替莫唑胺化疗的不良反应分析

Temozolomide adverse events and coping strategies in high-grade glioma patients with concurrent chemoradiotherapy

目的替莫唑胺是一种新型烷化剂，因其口服给药、生物利用度好、良好的血脑屏障通透性以及突出的治疗效果，越来越广泛地用于胶质瘤治疗，但其不良反应仍有待深入研究。本文探讨替莫唑胺不良反应的发生、后果、影响因素、防治原则。方法分析在同步放化疗当中使用替莫唑胺化疗的高级别胶质瘤患者的资料，包括肿瘤类型，替莫唑胺化疗期间血常规、血生化检查，不良反应等指标。依据药物毒副反应判定标准NCI-CTC3．0对不良反应进行判定。结果共33例患者使用替莫唑胺，年龄23-76岁，中位年龄46岁，男性18例，女性15例，均为高级别胶质瘤术后行替莫唑胺同步放化疗。其中血液学毒性发生4例（12．1％），胃肠道反应共15例（45．5％），乏力12例（36．4％），皮肤病变2例（6．1％），一过性视物模糊3例（9．1％）。除1例血液学毒性3～4级外，其余毒性均为1～2级。其中女性不良反应发生率高于男性，而肿瘤级别对不良反应无影响。结论替莫唑胺是目前胶质瘤治疗的常用药物，通过对替莫唑胺联合放射治疗过程中的不良反应分析，显示其不良反应较轻微，且给予对症处理后均能明显缓解。因此，在对恶性脑胶质瘤患者使用同步放射治疗及化学治疗中，替莫唑胺的应用是安全的。

Objective Temozolomide, an alkylating agent given in simple oral route of Ad- ministration,is used in conjunction with and after radiotherapy. This study aimed to evaluate the toxic effects of temozolomide when used in combination with radiotherapy, to observe the side effects of temozolomide,evaluate the clinical safety of the drug,and improve the quality of life in patients with glioma. Methods The data of glioma patients treated with TMZ （temozolomide） when used in combination with radiotherapy in Department of Oncology, Affiliated People＇ Hospital of Inner Mongolia Medical University were reviewed. Patients＇ tumor grade, TMZ regimen, blood tests, blood biochemical tests, and adverse reactions were analyzed. The adverse reactions were assessed according to the criteria of drug toxicity,the NCI-CTC（common toxicity criteria） 3.0. Results Total of 33 patients were enrolled,with an age of 23-76 years （average 46 years）. There were 18 males and 15 females. All the cases were diagnosed as high-grade gliomas and received concurrent chemoradiotherapy and treated with temozolomide. Hematologic toxicity was observed in 4 cases （ 12. 1% ）,nausea and vomiting in 15 cases （ 45. 5% ）,fatigue in 12 cases （ 36.4%） ,skin lesions in 2 cases （ 6. 1% ） ,and blurred vision in 3 cases（9. 1%） ,respectively. Adverse reactions were more frequently observed in females and in cases with concurrent chemoradiotherapy. There is no relationship between tumor grade and adverse reactions. Conclusion Temozolomide is commonly used in the treatment of malignant glioma, the toxic and side effects were observed during the process of concurrent chemoradiotherapy, the toxic and side effects were minor,and can be relieved obviously after symptomatic treatment. Therefore, temozolomide is a safe drug for malignant glioma treatment.