同步加量调强放疗联合替莫唑胺治疗恶性脑胶质瘤的临床观察

目的：观察同步加量调强放疗（SMART）联合替莫唑胺（TMZ）治疗恶性脑胶质瘤的近期疗效和安全性。方法：选择27例术后病理确诊为高级别胶质瘤（Ⅲ～Ⅳ级）的患者，放疗方法为脑局部SMART，放疗剂量临床靶区为50-54Gy（2．5～2．7Gy／f，4周共20f），计划靶区为38～40Gy（1．9～2Gy／f，4周共20f）；放疗同时口服TMZ，75mg／（群·d），每天1次空腹服药，治疗4周，之后再接受4～6个疗程的常规TMZ治疗，150mg／（m^2·d），每天1次空腹服药，连用5d，然后间隔23d进行下一周期。观察所有患者的近期疗效、生存率和不良反应情况。结果：治疗后患者的有效率为77．8％；中位生存期为11．5个月，1年生存率为43．57％，2年生存率为19．72％；所有患者均未见严重不良反应发生。结论：SMART联合TMZ治疗恶性脑胶质瘤近期疗效和安全性较好，并可缩短放疗时间。

Clinical Observation of Simultaneous Modulated Accelerated Radiotherapy Combined with Temozolomide in the Treatment for Malignant Glioma

OBJECTIVE： To observe the short-term efficacy and safety of simultaneous modulated accelerated radiotherapy （SMART） combined with temozolomide （TMZ） for malignant glioma. METHODS： A total of 27 malignant glioma cases （grade Ill-W） pathologically proved were enrolled. We prescribed 50-54 Gy （2.5-2.7 Gy/f, 4 weeks） in 20 fractions to the CTV and 38-40 Gy （1.9-2 Gy/f,4 weeks） in 20 fractions to the PTV, by cerebral SMART. They were additionally given TMZ 75 mg/（m2.d）, fasting medication once a day for consecutive 4 weeks, followed by 4-6 treatment courses of TMZ 150 mg/（mz. d）, fasting medication once a day for consecutive 5 days, 23 days interval. Short-term efficacy, survival rate and ADR were observed in all patients. RESULTS： The effective rate of patients was 77.8% after treatment. The median survival time was 11.5 months, and 1-year overall survival rate and 2-year overall survival were 43.57% and 19.72%, respectively. No serious adverse reactions were found among all patients. CONCLUSIONS： SMART combined with TMZ shows short-term efficacy and is safe for malignant glioma, and can shorten treatment course.