脑胶质瘤术后调强放疗联合替莫唑胺化疗的疗效 优先出版

·工作探讨·

2012年7月第9卷第21期

中国医药导报CHINA MEDICAL HERALD

脑胶质瘤（glioma ）是发病率最高的脑部肿瘤，约占40%。发病年龄多在30~40岁。脑胶质瘤中以星形细胞瘤最多，其次为胶质细胞瘤和少枝胶质细胞瘤，其临床表现为头痛、恶心、复视、癫痫等[1]。因脑胶质瘤呈浸润性生长，且位于重要结构，单纯手术难以完全切除，术后易复发。临床上常规手术治疗后放疗以提高患者生存率，减少复发，但效果仍不理想。替莫唑胺是一种新型烷化剂-咪唑四嗪类衍生物，具有广谱抗肿瘤活性，生物利用度高[2]。本研究在脑胶质瘤术后采用调强放疗联合替莫唑胺化疗，效果较好，现报道如下：1资料与方法1.1一般资料

选取2009年2月~2011年3月我院收治的脑胶质瘤患者78例。其中，男38例，女40例；年龄18～69岁，平均（35.2±4.1）岁；肿瘤部位：额叶25例，颞叶19例，顶叶19例，

枕叶12例，其他3例；术后检查残留46例，复发32例；病理分级：间变性星形细胞瘤22例，多形性胶质母细胞瘤23例，髓母细胞瘤5例，多形性胶质母细胞瘤17例，间变性室管膜瘤5例，原始神经外胚叶肿瘤2例，间变混合少枝星形胶质细胞瘤4例。KPS 评分≥60分，预计生存时间≥3个月。随机将78例患者平均分为实验组和对照组，每组39例，两组患者术后均给予调强放疗，实验组在调强放疗的基础上使用替莫唑胺化疗。两组患者性别、年龄、病理分级、肿瘤部位比较差异均无统计学意义（P >0.05），具有可比性。1.2方法

调强放疗：患者仰卧，面膜固定体位。CT 断层扫描，层厚5mm ，采集解剖图像和数据。根据ICRU50号文件进行靶区勾画肿瘤靶区GTV ，GTV 外扩3cm 为PT V （计划靶区）。PTV 每次95%剂量曲线为2.0Gy 。GTV 外扩3cm 放射至50Gy ，后缩野推量至60Gy 。替莫唑胺：口服给药，剂量200mg/（m 2·d ），4周重复1次。根据患者自身情况3～5个疗程。

脑胶质瘤术后调强放疗联合替莫唑胺化疗的疗效分析

胡江潘军骆志国明帮春湖北医药学院附属太和医院，湖北十堰442000

[摘要]目的探讨脑胶质瘤术后调强放疗联合替莫唑胺化疗的临床效果。方法选取2009年2月~2011年3月我院收治的脑胶质瘤患者78例，随机平均分为两组，每组39例。术后均给予调强放疗，实验组在调强放疗的基础上使用替莫唑胺化疗。对比近、远期临床效果及不良反应。结果实验组调强放疗联合替莫唑胺化疗，有效率为64.1%，疾病控制率为92.3%。对照组有效率为38.5%，疾病控制率为74.4%。两组患者有效率和疾病控制率对比差异有统计学意义（P <0.05）。实验组半年生存率为76.9%，一年生存率为64.1%；对照组半年生存率为59.0%，一年生存率为35.9%，两组对比均有显著差异（P <0.05）。实验组不良反应稍高于对照组，但差异无统计学意义（P >0.05）。结论

脑胶质瘤术后联合调强放疗和化疗具有协同效应，提高治疗效果，安全可靠，值得广泛推广。[关键词]脑胶质瘤；调强放疗；替莫唑胺[中图分类号]R739.4[文献标识码]C [文章编号]1673-7210（2012）07（c ）-0166-02

Analysis of curative effects of intensity modulated radiotherapy combined with Temozolomide chemotherapy after operation of cerebral glioma

HU Jiang PAN Jun LUO Zhiguo MING Bangchun

Taihe Hospital Affiliated Hospital of Hubei Medical College,Hubei Province,Shiyan 442000,China

[Abstract]Objective To investigate the clinical effects of intensity modulated radiotherapy combined with Temozolomide chemotherapy after operation of cerebral glioma.Methods A total of 78patients with cerebral glioma admitted to our hospi -tal from February 2009to March 2011were randomly divided into two groups.Both groups were given intensity modulated radiotherapy and the experiment group was given additional Temozolomide chemotherapy.Short-term and long-term clini -cal effects and adverse reactions were compared.Results In the experiment group,the effective rate was 64.1%and the disease control rate was 92.3%.In the control group,the effective rate was 38.5%and the disease control rate was 74.4%.The effective rates and the disease control rates were significantly different between the two groups (P <0.05).In the experiment group,the six months survival rate was 76.9%and the one year survival rate was 64.1%,and in the control group,the six months survival rate was 59.0%and the one year survival rate was 35.9%,with significant differences in both rates between the two groups (P <0.05).There were more adverse reactions in the experiment group than in the control group,with no significant difference (P >0.05).Conclusion Intensity modulated radiotherapy combined with Temozolomide chemotherapy after cerebral glioma have synergistic effects,can improve curative effects,is safe and reliable,thereby wor -thy of wide promotion.

[Key words]Cerebral glioma;Intensity modulated radiotherapy;Temozolomide

[作者简介]胡江（1975.12-），女，硕士，湖北武汉人，主治医师；研究方向：肿瘤放疗。

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