恶性脑神经胶质瘤辅助化疗的初步探讨

目的：评价含替尼泊苷联合化疗方案对恶性脑胶质瘤的治疗效果和毒副作用，探讨有效的辅助化疗方案，以期提高恶性脑神经胶质瘤患者的疗效，延长生存期。方法：不能手术，术后残留或复发的恶性脑胶质瘤25例，大脑半球胶质瘤15例，其中星形细胞瘤Ⅲ级11例，Ⅳ级4例，年龄21－75岁，平均44岁，男8例，女7例；脑干胶质瘤8例，年龄6－14岁，平均11岁，男女各4例；小脑胶质瘤2例。采用含替尼泊苷的联合化疗方案：（1）紫杉醇加替尼泊苷；替尼泊苷200mg/m^2,分3d（第1－3天），静脉输入；紫杉醇135mg/m^2，静脉输入，第1天，3周后可重得。（2）司莫司汀加替尼泊苷：替尼泊苷（用法同前）；司莫司汀100mg/m^2，第1天晚顿服，6周后可重复。第一周期化疗后常规局部外放疗，照射总计量50－60Gy。结果：25例患者有效17例，总有效率68％，其中大脑半球胶质瘤有效率60％（9／15），脑干胶质瘤有效率87．5%(7/8），小脑胶质瘤有效率50％（1／2）。经χ^2检验，两种化疗方案有效率无性差异。主要毒性为骨髓抑制，特别是中性粒细胞减少，其中Ⅲ，Ⅳ度毒性反应5例，占20％，经对症处理均恢复正常。远期疗效正在观察中。结论：替尼泊苷加紫杉醇或司莫司汀联合化疗同时放疗治疗恶性脑胶质瘤，安全、有效。为脑瘤辅助化疗提供了新方案。

Primary Exploration of Adjuvant Chemotherapy on High-grade Neuroglioma

Objective It is to evaluate the curative effects and the relevant toxicty and side effets on curing brain malignant neuroglioma by using teniposide combination chemotherapy. It also discusses the effective adjuvant chemotherapy programs in order to prolong the survival time of the patients. Methods Among 25 cases of brain malignant neuroglioma that can not be cured with operation or that are recrudescent diseases after operation, there are 15 cases for the astrocytoma of cerebral hemisphere, 8 cases for brain stem and 2 cases for cerebellum. The treatment regimen consisted of paclitaxel and teniposide, or semustine and teniposide. Patients also received the routine radiotherapy after the chemotherapy. The curative effects and the toxicty and side effects were observed in these patients. Results Among 25 cases, 17 patients were effective, total effective rate is 68%. The effective rates of cerebral hemisphere, brain stem and cerebellum astrocytomas are 60%(9/15), 87.5(7/8) and 50%(1/2), respectively. The dose-limiting toxicity is the bone marrow suppression, especially is granulocytopenia. Conclusion It is a safe and effective way to cure brain malignant neuroglioma by using paclitaxel and teniposide, or semustine and teniposide combination chemotherapy, combined with radiotherapy simultaneously.