适形调强放疗序贯替莫唑安联合阿帕替尼治疗术后高级别脑胶质瘤的疗效

Efficacy of IMRT Sequential Apatinib and TMZ in Treatment of Postoperative High Grade Glioma

目的回顾性分析适形调强放疗(intensity modulated radio therapy,IMRT)序贯替莫唑安(temozolomide,TMZ)联合阿帕替尼(Apatinib)治疗术后高级别脑胶质瘤患者的临床疗效。方法回顾2013年6月至2019年6月41例术后高级别脑胶质瘤临床病例,术后均病理证实为高级别恶性脑胶质瘤(WHO III^IV级)。两组病例术后均予适形调强放疗(IMRT),PGTV 56~66 Gy,PCTV 50.4~54 Gy,常规分割1.8~2.5 Gy/次,同步TMZ 75 mg/m^2D1~42化疗,随机分组对照组(IMRT+TMZ)20例:序贯替莫唑安150~200 mg/m^2 D1~5,4周一疗程,6~8疗程;实验组(IMRT+TMZ+Apatinib)21例:序贯替莫唑安150~200 mg/m^2 D1~5,4周一疗程,6~8疗程,每天服用阿帕替尼500~725 mg直至病情进展或出现无法耐受的毒副反应。治疗周期结束后观察两组近期及远期临床疗效、淋巴细胞亚群水平及毒副反应情况。结果两组临床数据中对照组和实验组6个月客观有效率(ORR)分别为40.0%和71.4%,疾病控制率(DCR)分别为25.0%和57.1%,无疾病进展生存期(PFS)分别为(5.6±1.1)个月和(3.3±2.8)个月,总生存时间(OS)分别为(7.5±3.2)个月和(10.2±3.9)个月,两组数据ORR、DCR、PFS、OS比较有统计学差异(P<0.05);实验组CD4、CD8及CD4/CD8水平均高于对照组;实验组中高血压、出血、蛋白尿及黏膜炎发生率高于对照组,差异有统计学意义(P<0.05),其他毒副反应差异无统计学意义(P>0.05)。结论适形调强放疗序贯替莫唑安联合阿帕替尼治疗术后高级别脑胶质瘤较适形调强放疗序贯单药替莫唑安具有更好的临床疗效,可临床推广使用。

Objective To retrospectively analyze the clinical results of patients with postoperative high grade glioma treated with IMRT sequential Temozolam(TMZ)combined with Apatinib.Me thods From June 2013 to June 2019,41 patients with postoperative high grade glioma were randomly divided into the control group and the experimental group,all of them were pathologically proved to be malignant gliomas(WHO III^IV grade).The patients in both groups were treated with IMRT PGTV 56~66 Gy,PCTV 50.4~54 Gy,1.8~2.5 Gy one time,Sync TMZ 75 mg/m^2 D1~42,The control group(TMZ+IMRT)20 cases were sequential treated with TMZ 150~200 mg/m^2 D1~5,4 weeks one course and 6~8 courses.The experimental group(IMRT+TMZ+Apatinib)21 patients were sequential treated with TMZ 150~200 mg/m^2 D1~5,4 weeks one course and 6~8 courses,and Apatinib 500-725 mg/d until the disease progressed or could not be tolerated.The clinical efficacy,T cell subsets,and adverse reactions were compared between the two groups after the end of the treatment cycle.Re s ults The Objective Effective Rate(ORR)was 40.0%in the control group and 71.4%in the experimental group within 6 months.The Disease Control Rate(DCR)of the control group was 25.0%and 57.1%in the experimental group within 6 months.The Progression Free Survival(PFS)was 5.6±1.1 months and 3.3±2.8 months,and the Over Survival time(OS)was 7.5±3.2 months and 10.2±3.9 months respectively.There were statistically significant differences in the ORR,DCR,PFS,OS between the two groups.The levels of CD4,CD8 and CD4/CD8 in the experimental group were higher than those in the control group(P<0.05).The incidences of hypertension,bleeding,albuminuria and oral mucositis in the experimental group were higher than that in the control group(P<0.05).Conclus ion IMRT sequential TMZ combined with Apatinib is more effective than TMZ in the treatment of postoperative high grade glioma,which is worth popularizing in clinical practice.