调强放疗联合替莫唑胺治疗高级别脑胶质瘤的长期疗效分析

Long-term Efficacy Analysis of Intensity Modulated Radiation Therapy Combined with Temozomide in the Treatment of High-grade Gliomas

目的:观察调强放射治疗(IMRT)联合替莫唑胺(TMZ)治疗高级别脑胶质细胞瘤(HGG)患者的生存情况,探讨影响HGG患者预后的因素。方法:选取2008年4月至2015年4月我院收治的初治Ⅲ~Ⅳ级脑胶质细胞瘤术后患者53例,所有患者行调强放疗联合同步及辅助TMZ化疗。放疗采用IMRT技术,剂量GTVp/GTVtb64.2Gy/30f,PTV1 60Gy/30f,PTV2 54Gy/30f;放疗期间同步口服TMZ 75mg/(m^2·d)。同步放化疗结束后4周行辅助化疗,TMZ 150~200mg/(m^2·d),连用5天,21~28天/周期,共6周期。观察患者的总生存率(OS)、无进展生存率(PFS),并对患者性别、年龄、KPS评分、手术切除程度、病理分级、手术至放疗间隔时间、是否行辅助化疗等因素对患者的预后影响进行分析。结果:(1)全组患者中位随访时间为47个月(16~100个月)。(2)39例患者出现肿瘤进展或复发,其中死亡34例;因第二原发肿瘤(宫颈癌)死亡1例。(3)全组3、5年OS分别为37.3%和26.7%,3、5年PFS分别为28.5%和19.0%。(4)多因素分析显示手术切除程度(P=0.027,HR=0.383)、性别(P=0.011,HR=0.315)、是否完成6周期辅助化疗(P=0.028,HR=0.363)为影响患者OS的独立影响因素;年龄(P=0.006,HR=2.638)及手术切除程度(P=0.005,HR=0.318)是影响患者PFS的独立预后因素。结论:IMRT联合及辅助TMZ治疗HGG的疗效肯定,手术切除程度、性别、年龄及辅助化疗周期数是影响HGG患者预后的独立影响因素。

Objective： To observe the prognosis of patients with high-grade gliomas （HGG） treated with intensity modulated radiation therapy （IMRT） combined with temozomide （TMZ）, and to explore the related influential factors. Methods： Fifty-three postoperative patients diagnosed as 111 - 1V grade glioma during April 2008 and April 2015 were enrolled. All patients were treated by IMRT combined with concurrent and adjuvant TMZ chemotherapy. The dose of GTVp/ GTVtb, PTV1, PTV2 was 64.2Gy/30f, 60Gy/30f, and 54Gy/30f, respectively. TMZ [75mg/（m^2 · d） was given con- currently. TMZ [ 150 - 200mg/（ m^2· d） ] was administered for consecutive 5 days, 21 to 28 days as a cycle, 6 cycles in total 4 weeks after the concurrent chemoradiotherapy. The overall survive （OS） and progress free survive （PFS） were observed. The influence of gender, age, KPS score, surgical resection degree, pathological grading, interval time between surgery to radiotherapy, receiving adjuvant chemotherapy or not on the prognosis of patients were analyzed. Results： （1） The median follow-up time was 47 months （16 to 100 months）. （2）Tumor progression or recurrence occurred in 39 patients, among which 34 died, and 1 case died from second primary tumors （cervical cancer）. （3）The 3 and 5-year OS was 37.3% and 26.7% , respectively; the 3 and 5-year PFS was 28.5% and 19.0 %,respectively. （4）Multivariate analysis showed that the extent of surgical resection （P = 0. 027, HR = 0. 383 ） , gender （P -- 0.011, HR = 0. 315 ）, completing 6 cycles of adjuvant chemotherapy （ P = 0. 028, HR = 0. 363 ） were independent influencing factors for OS ; age （P = 0. 006, HR = 2. 638 ） and the degree Of resection （P = 0. 005, HR --0.318 ） were independent influencing factors for PFS. Conclusion： The efficacy of IMRT combined with TMZ in the treatment of HGG is positive. It suggests that the degree of surgical resection, gender, age, and the number of adjuvant chemotherapy cycles are independent prognostic factors for patients with HGG.