117例高分级脑胶质瘤术后同步放化疗前瞻性研究.docVIP

117例高分级脑胶质瘤术后同步放化疗前瞻性研究 　　【摘要】 目的 回顾性分析并评价术后同步放化疗治疗高分级脑胶质瘤的疗效。方法 117例高分级脑胶质瘤患者术后随机分为观察组(58例)和对照组(59例)。对照组给予术后常规放疗，总剂量DT=60 Gy/6周。观察组化疗与放疗同步进行。在脑部放疗20~30 Gy时，口服司莫司汀(Me-CCNU)150 mg，放疗期间每周一次，共3~4次，放疗结束后每6~8周一次，共6~8次。结果 局部近期疗效观察组和对照组有效率分别为68.97％和25.42％，两者比较差异有统计学意义(P 　　【关键词】脑胶质瘤；放射治疗；化疗；司莫司汀 　　Clinical observation on combined chemo-radiotherapy in high grade intracranial glioma 　　 　　QI Li-wei, FAN Yu-wei,LI yu,et at.Department of Radiation Oncology,The First People’s Hospital of Liangyungang city,Lianyungang 222000,China 　　 　　【Abstract】 Objective To evaluate the efficacy of postoperativeconcurrent radiochemotherapy for high grade intracranial glioma. Methods 117 cases of postoperative intracranial glioma were randomized into observation group (58 cases) and control group (59 cases). In the control group, routine postoperative external irradiation were administered with a total dose of 60 Gy/6weeks. In the observation group, chemotherapy was concurrently with radiotherapy. When the irradiative dose was 20 to 30 Gy, patients received Me-CCNU 150 mg orally, followed by once every week, the total cycles were three to four during the radiation and the total cycles were six to eight.Results The local response rate of the observation group and control group was 68.97% and 25.42%，respectively. There was significant difference between them(P 　　1.3 观察方法 放疗期间每周监测血象，每半月监测肝肾功能，放疗结束后每个月监测血常规、肝肾功能。治疗结束时及治疗后每3个月复查头颅MRI。观察肿瘤变化、复发时间、生存时间、死亡原因等。 　　1.4 疗效评定标准 对比手术后放疗前及放疗结束后3、6个月时头颅MRI，分为完全缓解(CR)：肿瘤病灶消失；部分缓解(PR)：肿瘤缩小50%；无变化(NC)：肿瘤缩小25%或出现新病灶。CR+PR者计为有效。血液毒性、急性放射性脑损伤和晚期放射性脑损伤参照放射肿瘤协作组(RTOG)和欧洲癌症研究治疗中心(EORTC)的放射治疗毒性标准分级为1~4级如表2、3?? 　　中枢神经系统无变化功能完全正常,有轻微神经体征,无需用药出现神经体征,需家庭照顾/可能需护士帮助/包括类固醇的用药/可能需抗癫痫药物有神经体征,需住院治疗严重神经损伤,包括瘫痪、昏迷或癫痫发作，即使用药仍每周3次/需住院治疗 　　血液学白细胞(×1000)≥4.03.0~10075~0.05)；2年生存率，A、B组分别为43.10%(25/58)与15.25%(9/59)，两者比较差异有统计学意义(χ?2=6.108，P0.05)；4年生存率，A、B组分别为12.09%(7/58)与1.69%(1/59)，两者比较差异无统计学意义(χ?2=2.930，P0.05)。可以看出A组生存率在数值上要优于B组，但是经处理后仅2年生存率差异有统计学意义。 　　2.3 近期急性反应与