高级别恶性脑胶质瘤术后三维适型放疗联合经颈动脉灌注化疗的效果分析

Efficacy analysis of three-dimensional conformal radiotherapy combined with transcatheter arterial infusion chemotherapy in treatment of high-grade malignant glioma

目的评价三维适型放疗(3Dc RT)联合经颈动脉灌注化疗对高级别脑恶性胶质瘤(HGG)术后患者的临床疗效。方法收集2009年3月~2013年2月37例经病理证实为HGG术后患者,采用随机数字表法分为两组,对照组18例(Ⅲ级8例、Ⅳ级10例)术后仅给予三维适型放疗,联合治疗组19例(Ⅲ级9例、Ⅳ级10例)术后给予三维适型放疗联合经颈动脉灌注化疗。对照组术后单纯三维放疗,联合治疗组应用ACNU[2.0 mg/(kg·次)]、VM-26(50 mg/次)药物进行动脉灌注化疗。放疗单次量为2.0 Gy/次,1次/d,5次/周,DT 50~56 Gy。化疗间隔时间与次数根据患者全身及肿瘤情况决定。观察两组患者的近期、远期疗效,不良反应发生情况。结果对照组治疗后6、9、12、24、36个月的生存率分别为77.78%、66.67%、50.00%、38.89%、22.22%,联合治疗组分别为89.47%、78.95%、68.42%、52.63%、36.84%,两组比较,差异有统计学意义(P<0.05)。对照组中位生存时间为11.2个月,联合治疗组为18.6个月,两组的中位生存时间差异有统计学意义(χ~2=8.76,P<0.05)。结论 HGG术后三维适形放疗联合经颈动脉灌注化疗较单纯三维放疗可显著提高患者生存率、延长其生存时间。

Objective To evaluate the clinical efficacy of hree-dimensional conformal radiotherapy（3Dc RT） combined with transcatheter arterial infusion chemotherapy in treatment of high-grade malignant glioma（HGG）.Methods From March 2009 to February 2013,37 postoperative patients with HGG treated in our hospital confirmed by pathology were divided into two groups according to the random number table method.The control group（n =18;grade Ⅲ in 8 cases,grade Ⅳ in 10 cases） only underwent 3Dc RT,the combined treatment group（n=19;grade Ⅲ in 9 cases,grade Ⅳ in 10cases） underwent 3Dc RT combined with transcatheter arterial infusion chemotherapy.In the two groups.The combined treatment group was treated with ACNU [2.0 mg/（kg·time）] and VM-26（50 mg/time） for arterial chemoembolization.Single radiation quantity was 2.0 Gy/（time·d）,five times per week,the radiotherapy dose（DT） was 50-56 Gy.The times and frequency of chemotherapy were determined according to the patient′s body and tumor situation.The short-term and longterm efficacy and adverse reaction in the two groups were obseved.Results Survival rate of 6,12,24,36 months after treatment in the control group was 77.78%,66.67%,50.00%,38.89%,22.22% respectively,and it was 89.47%,78.95%,68.42%,52.63%,36.84% respectively in the combined treatment group,and there was a statistical difference between two groups（P〈0.05）.The median survival time was 11.2 months in the control group and that was 18.6 months in the combined treatment group,the differences were significant（χ~2=8.76,P〈0.05）.Conclusion 3Dc RT combined with transcatheter arterial chemoembolization can significantly improve the survival rate and prolong the survival time of patients with HGG than radiotherap alone.