单独应用替莫唑胺对手术后脑原发性恶性胶质瘤患者进行化疗的临床观察

Clinical observation in chemotherapy with temozolomide alone in postoperative malignant primary cerebral glioma

目的观察单独应用新型口服烷化剂替莫唑胺(temozolomide,TMZ)治疗手术后脑原发性恶性胶质瘤患者的疗效和安全性。方法选择17例年龄为18～65岁、经病理检查确诊为脑恶性胶质瘤(Ⅲ、Ⅳ级)并且手术后未曾接受过放疗或其他化疗药物治疗及复发的患者。给予替膜唑胺150～200mg/(m2·d),连续空腹口服5d,28d为一个疗程(本组患者治疗了2～6个疗程)。每一疗程均随访检查患者的临床表现、血常规及肝、肾功能,以判断患者能否耐受。替莫唑胺治疗第二、三及六个疗程末施行相应的增强CT或MR检查,与化疗前的影像学资料进行比较,判断肿瘤实体变化情况。结果17例患者中1例肿瘤完全消失,1例肿瘤体积缩小>50%,6例病情稳定,9例肿瘤体积增大,治疗有效率为47.1%。患者6个月生存率为58.8%(10/17),生存最长者已达11个月。化疗期间患者的不良反应及骨髓毒性较轻微。结论替莫唑胺能有效地延缓肿瘤复发,且安全性和耐受性较好,为一有良好前景的化疗药物。

Objective To observe the curative effects and safety of temozolomide(TMZ),a novel oral alkylating agent,in treating postoperative primary malignant glioma.Methods Seventeen patients,aged18-65years,pathological definitely diagnosed as malignant glioma (gradeⅢorⅣ),not treated with radiotherapy or chemotherapy postoperatively,were enrolled in the study.Temozolomide150-200mg /m 2 was administered once daily for5days and28days as a treatment course(2-6courses were performed in these cases).Physical examination was performed on all patients at each dosing cycle,blood routine,hepatic and renal function test were taken to determine patients’tolerability and safety of the drug and the clinical features were also ob-served.Enhanced CT or MRI were performed and compared with the original imagings before treatment with TMZ to determine the changes of solid tumors at the end of2,3and6courses.Results Of the17cases,one case tumor completely disappeared,one case showed tumor volume decreased above50%,6cases showed remain stable,9cases showed enlargement of tumor volume.The effective rate of such treatment was47.1%,six-month survival rate was58.8%.The longest survival has reached11months.During the chemotherapy,adverse effects and myelotoxicity were slight and all of the patients were well tolerated.Conclusion The TMZ can effectively delay the recurrence of malignant glioma with safety and good tolerability.Therefore it is a good prospective chemotherapeutic agent.