顺铂联合替莫唑胺治疗O^6-甲基鸟嘌呤-DNA甲基转移酶启动子甲基化胶质瘤的近期疗效观察

Short-term clinical effects of cisplatin combined with temozolomide in treatment of gliomas with mgmt promoter gene methylation positive after surgery

目的采用顺铂联合替莫唑胺方案与单用替莫唑胺方案对O^6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)启动子甲基化胶质瘤术后辅助化疗,比较两种化疗方案的近期疗效及不良反应的差异。方法选择2016年6月至2016年12月在安徽医科大学第一附属医院神经外科就诊,术后组织病理证实为胶质瘤(WHOⅡⅣ级)且分子病理示MGMT启动子甲基化阳性的患者18例为处理组;选择同期手术且符合纳入标准的患者16例为对照组,所有处理组和对照组患者都采取同步放化疗加6个周期序贯化疗。结果处理组与对照组患者的客观应答率分别为66.66%和31.25%,差异有统计学意义(P=0.042);癫痫发生率分别为22.22%和12.50%,差异无统计学意义(P=0.660);且未发生严重不良反应。结论 MGMT启动子甲基化胶质瘤术后采用同步放化疗+顺铂联合替莫唑胺化疗疗效优于同步放化疗+替莫唑胺单药化疗,两组患者癫痫发生率差异无统计学意义,且未发生严重不良反应。

Objective To investigate the difference of short-term clinical effects in the treatment of gliomas with O^6-methylguanine DNA-transferase（MGMT） promoter gene methylation positive after surgery by cisplatin combined with temozolomide or temozolomide only. Methods A total of 34 patients with pathologically confirmed gliomas（WHO Ⅱ-Ⅳ） with MGMT promoter gene methylation positive were enrolled. All patients were pretreated with concurrent radiochemotherapy. The treatment group including 18 patients were treated with cisplatin plus temozolomide（TMZ）. The control group including 16 patients were treated with TMZ only. Results The objective response rate（ORR） was 66. 66 % in the treatment group,and the ORR was 31. 25% in the control group. There was a significant difference（P = 0. 042）. The incidence rate of epilepsy was 22. 22% and 12. 50%,respectively,in the treatment group and the control group. However,there was no significant difference（P = 0. 660）. The common adverse reactions were including neutropenia,decreased appetite,nausea,vomiting and increased creatinine. Conclusion Scheme of cisplatin combined with TMZ after concurrent radiochemotherapy may improve efficacy in patients of gliomas with MGMT promoter gene mythelation positive,and the adverse reactions were tolerable. It is worth being generalized in clinical application.