高级别脑胶质瘤术后同期加量调强放疗联合替莫唑胺化疗的临床观察

Clinical observation of simultaneous integrated boost intensity modulated radiation therapy concurrent with temozolomide for postoperative high-grade glioma

目的探讨同期加量调强放疗(SIB-IMRT)联合化疗治疗高级别脑胶质瘤的临床疗效和安全性。方法回顾性分析2013年5月至2015年5月43例初治高级别胶质瘤术后患者的临床资料。患者全部采用术后瘤床区SIB-IMRT,予瘤床区60 Gy/25次,2. 4 Gy/次,瘤床区外扩2 cm,50 Gy/25次。放疗期间接受同步化疗,从放疗第1天开始同步化疗,口服替莫唑胺75 mg/m^2,放疗结束后4周予替莫唑胺(150 mg/m^2)辅助化疗6个周期,观察1、2年生存率和无进展生存率及治疗期间的不良反应。结果 43例患者全部完成治疗,中位随访24个月,1、2年生存率分别为81. 4%、55. 8%,1、2年无进展生存率分别为65. 1%、44. 2%。其中,病理分级为Ⅲ级患者的1、2年生存率分别为88. 0%、72. 0%,1、2年无进展生存率分别为76. 0%、60. 0%;病理分级为Ⅳ级患者的1、2年生存率分别为72. 2%、33. 3%,1、2年无进展生存率分别为50. 0%、22. 2%。Ⅲ级患者的2年生存率和无进展生存率明显优于Ⅳ级患者,差异有统计学意义(P<0. 05)。治疗期间主要不良反应为急性中枢神经毒性、血液学毒性、胃肠道反应,未观察到3级以上毒性反应及放射性脑坏死。结论 SIB-IMRT联合化疗治疗高级别脑胶质瘤术后患者的不良反应大部分能耐受,安全性良好,总的治疗时间有所缩短,值得临床上进一步研究。

Objective To explore the clinical efficacy and safety of simultaneous integrated boost intensity modulated radiation therapy(SIB-IMRT)concurrent with chemotherapy for postoperative high-grade glioma(HGG).Methods Retrospective analysis was performed on the clinical data of43patients with postoperative HGG from May2013to May2015.All the patients received tumor bed SIB-IMRT.The volume of tumor bed area was60Gy/25times,2.4Gy/times,and the tumor bed area expansion was2.0cm,50Gy/25times.All the patients received concurrent chemotherapy,and temozolomide was given75mg/m2from the first day of radiation therapy,and adjuvant temozolomide(150mg/m2)for6cycles was given4weeks after the end of radiation therapy.The short-term curative effect,the1-and2-year overall survival rates,1-and2-year progression-free survival rates and the side effects of treatment were observed.Results A total of43patients completed treatment with a median follow-up of24months.The1-and2-year overall survival rates were81.4%and55.8%,respectively,and the1-and2-year progression-free survival rates were65.1%and44.2%.The1-and2-year overall survival rates of patients with pathological gradeⅢwere88.0%and72.0%,respectively,and the1-and2-year progression-free survival rates were76.0%and60.0%,respectively.The1-and2-year overall survival rates of patients with pathological gradeⅣwere72.2%and33.3%,respectively,and the1-and2-year progression-free survival rates were50.0%and22.2%,respectively.The2-year survival rate and2-year progression-free survival rate of patients of gradeⅢwere obviously better than those of patients of gradeⅣ,and the differences were statistically significant(P<0.05).The common adverse reactions during the treatment were acute toxicity of central nervous,hematology toxicity and gastrointestinal reaction.Over grade3toxic reaction and radiation brain necrosis were not observed.Conclusion SIB-IMRT for postoperative high-grade HGG shows good tolerance,and the total treating duration is shortened.It worth further study in clinical practice.