伽玛刀联合紫杉醇治疗高级别胶质瘤的临床研究

Combined gamma knife with paclitaxel for recurrent high grade glioma

目的探讨伽玛刀联合紫杉醇治疗术后复发的高级别胶质瘤的临床疗效及不良反应。方法将73例胶质瘤术后患者分为联合治疗组(35例)和伽玛刀组(38例)。联合治疗组在伽玛刀治疗前2h静脉滴注紫杉醇100mg/m^2,伽玛刀组仅行伽玛刀治疗。所有患者伽玛刀治疗方案均采用50%剂量曲线包绕病灶,病灶中心剂量28~32Gy,周边剂量14~16Gy。结果联合治疗组与伽玛刀组近期有效率分别为37.1%和39.5%,无统计学差异(P=0.838);近期疾病控制率分别为97.1%和81.6%,两组间比较有统计学差异(P=0.041);生活质量改善率分别为42.9%和42.1%,无统计学差异(P=0.948);两组中改善及稳定的患者比例分别为97.1%和76.3%(P=0.010);无进展生存率分别为57.1%和34.2%,两组间比较有统计学差异(P=0.049);总生存率分别为17.1%和13.2%,组间比较无统计学差异(P=0.634)。治疗不良反应发生率两组比较无统计学差异(P=0.258)。结论伽玛刀联合紫杉醇治疗能提高术后复发高级别胶质瘤患者的近期疾病控制率,提高临床症状稳定改善率,并能延长患者无进展生存期,改善生活质量。

Objective To evaluate the clinical efficacy and safety of combined gamma knife with paclitaxel therapy for reoccurred high grade glioma. Methods Seventy three patients were randomized into two groups：35 patients received gamma knife plus paclitaxel therapy, 38 patients received gamma knife therapy only. Paclitaxel was given by intravenous drip at a dose of 100mg/m2.Gamma knife therapy was adopted at 50% isodose of 14~16Gy. Results The CR＋PR rate and disease control rate （CR＋PR＋SD） in gamma knife plus paclitaxel group and gamma knife therapy group were 37.1%vs 39.5%（P=0.838） and 97.1%vs 81.6%（P=0.041）, respectively. KPS improvement rate, steady rate, progression- free survival （PFS） rate in gamma knife plus paclitaxel group and gamma knife therapy group were 42.9%vs 42.1%（P=0.948）, 97.1%vs 76.3%（P=0.010） and 57.1%vs 34.2%（P=0.049）, respectively. Overal survival rate in gamma knife plus paclitaxel group and gamma knife therapy group was 17.1%and 13.2%（P=0.634） respectively. There was no significant difference in side effect rate between two groups （P=0.258）. Conclu-sion Gamma knife plus paclitaxel therapy can increase disease control rate, prolong PFS time and improve the quality of life in reoccurred high grade glioma patients.