高分级胶质瘤术后放射治疗加后期同步化疗的前瞻性研究

Prospective study on postoperative irradiation and concomitant chemotherapy for brain high-grade glioma

目的 分析高分级胶质瘤术后单纯放射治疗及放射治疗加化疗的疗效。方法 对 57例高分级胶质瘤进行前瞻性分组研究 ,单纯放射治疗 (单放 )组 2 9例 ,放射治疗加化疗 (放化 )组 2 8例。 2个组患者均在术后 2～ 4周开始常规放射治疗 ,采用6 0 Coγ射线先全脑照射 40Gy 4周后缩为局部野追加 2 0Gy2周。放化组在全脑照射 30Gy后加用化疗 ,方案为替尼泊甙 1 0 0mg、氟尿嘧啶 750mg第 1～ 5天静脉滴入 ,洛莫司汀 1 2 0mg第 1天口服 ,4周重复 1次 ,共 4～ 6个周期。结果 1、3、5年生存率单放组分别为 58.6 %、2 7.5 %、1 0 .3 % ,放化组分别为 75 .0 %、53 .5 %、32 .1 % ,放化组高于单放组(P <0 .0 5)。手术全切的 1、3、5年生存率分别为 89.4%、68.4%、52 .6 % ,明显高于大部切除的 72 .4%、34 .4%和 6 .9% (P <0 .0 1 )。结论 高分级胶质瘤术后采用放射治疗加化疗的综合治疗可提高疗效 。

Objective To analyze the clinical results of brain high-grade(HG) gl ioma treated with concomitant postoperative radiation and chemotherapy (R+C),com pared with postoperative radiotherapy(R) only. Methods From May 1993 to January 1997,57 patients with operated brain HG glioma were randomized to receive either R+C (28 cases) or R(29 cases) . All the patients received radical radiotherapy in 2-4 weeks after their operation. Total brain irradiation of 40?Gy was admin ist ered over four weeks with 60 Co γ-rays and then, a local boost of 20?Gy over two w eeks was supplemented with cone-down portals. In the R+C group,chemotherapy was concomitantly given(Vm-26 100?mg ivd d1-5,5睩u 750?mg ivd d1-5, CCNU 120? mg po d1, repeated after 4 weeks over 4-6 cycles after 30?Gy total brain irradiation. Results The 1-,3- and 5-year survival rates were 58.6%,27.5%,10.3% in the R group and 75.0%,53.5%,32.1% in the R+C group, respectively. Chemotherapy regimen combined with R had a significant impact on improving the long-term survival rates (P<0. 05). The 1-,3- and 5- year survival rates for patients with complete tumor re sec tion were superiorer very significantly to the rates with partial resection (89. 4%,68.4%,52.6% vs.72.4%,34.4%,6.9%,P<0.01). Conclusions Radiation combined with chemotherapy is evidently able to improve the ultimate outcome for patients with postoperative brain HG glioma,even though there is a close relation between the survival with the thoroughness of surgical extirpation.