脑胶质瘤术后三维适形放疗加同步化疗的临床观察

背景与目的：脑胶质瘤发病率高，预后差，寻找新的治疗方法成为这种疾病研究的热点。本研究通过前瞻性随机对照研究来观察三维适形放疗（3D—CRT）联合替莫唑胺同步化疗治疗脑胶质瘤术后残留患者的临床疗效。方法：62例术后有残留的脑胶质瘤患者前瞻性分组：单纯三维适形放疗（单放组）及三维适形放疗加同步化疗（放化组），各31例。两组均接受三维适形放疗，6MV-X射线，2．0Gy／f，1次／天，5次／周，处方剂量50460Gy／5-6周。放化组加用替莫唑胺75mg／（m^2·d），从放疗第1天开始口服到放疗结束，随后继续给予替莫唑胺150-200mg／（m^2·d），治疗5d，每28d为1个周期，共3～6个周期。结果：单放组总有效率35．5％（11／31），放化组61．3％（19／31），统计学差异显著（P=0．042）；两组生存比较无统计学差异（P=0．263）。分层分析显示：病理Ⅲ级脑胶质瘤同步放化疗生存优于单纯放疗组（P=0．043）。结论：病理Ⅲ级脑胶质瘤术后三维适形放疗联合同步化疗，可以取得较单纯三维适形放疗更好的疗效。

Clinical observation in 3 dimensional conformal radiotherapy (3D-CRT) concurrent chemotherapy in treatment of postoperative cerebral gliomas

Background and purpose: Cerebral gliomas is one of the common brain tumors, and has a poor prognosis. Therefore, multidisciplinary treatment strategy has been much investigated recently. This study investigated the efficacy of 3 dimensional conformal radiotherapy (3D-CRT) concurrent with Temozolomide chemotherapy in the treatment of postoperative cerebral gliomas. Methods: Sixty-two patients with cerebral glioma who had residual tumor surgery after surgery were randomized into 3D-CRT group (radiotherapy group, n=31) and 3D-CRT concurrent chemotherapy group (chemoradiotherapy group, n=31) prospectively. All patients received a dose of 50-60Gy/25-30F/5-6 weeks by 6MV-X ray, 1fx/day, 5 times a week. Chemotherapy regimen was Temozolomide: 75 mg/(m~2·d),concomitantly with radiotherapy,followed by 150-200mg/(m~2·d)for 5 days,28 days per cycle for total 3-6 cycles. Results: The total response rate was 35.3% (11/31) in the radiotherapy group, and 61.3% (19/31) in the chemoradiotherapy group. The difference was significant (P=0.042). But no significant difference was observed in terms of survival in the two groups (P=0.263). Stratified analysis showed that patients with grade Ⅲ gliomas in chemoradiotherapy group had better prognosis than those in the radiotherapy group (P=0.043). Conclusion. 3D-CRT concurrent with chemotherapy can improve the survival of pathological grade Ⅲ gliomas.