替莫唑胺在胶质瘤化疗中的不良反应分析

背景与目的:替莫唑胺越来越广泛地用于胶质瘤的治疗,其不良反应仍有待深入研究。本文探讨替莫唑胺的不良反应的发生情况、后果、影响因素、防治原则。方法:分析四川大学华西医院神经外科使用替莫唑胺治疗的胶质瘤患者的资料,包括肿瘤级别,是否行替莫唑胺同步放化疗,替莫唑胺化疗期间血常规、血生化检查,不良反应等。依据药物毒副反应判定标准NCI-CTC 3.0对不良反应进行判定。结果:共有123例患者使用替莫唑胺,年龄23～81岁,中位年龄46岁,男性65例,女性58例。高级别胶质瘤81例,其中术后行替莫唑胺同步放化疗32例,单用替莫唑胺辅助治疗49例,低级别胶质瘤42例使用替莫唑胺单纯辅助治疗。血液学毒性发生16例(13.0%),胃肠道反应共54例(44.3%),疲乏46例(37.4%),皮肤病变6例(4.9%),一过性视物模糊8例(6.5%)。除3例血液学毒性3-4级外,其余毒性均为1-2级。其中女性不良反应发生率高于男性,术后行替莫唑胺同步放疗的患者高于单纯替莫唑胺化疗者。肿瘤级别对不良反应无影响。结论:替莫唑胺不良反应相对轻微,偶发严重的不良反应,应密切监测。女性患者、进行过替莫唑胺同步放化疗的患者不良反应发生率高,如何控制其不良反应,仍值得探讨。

The Adverse Effects Analysis of Temozolomide in Glioma Chemotherapy

BACKGROUND & OBJECTIVE: Temozolomide(TMZ) is widely used in the management of glioma.The adverse effects of TMZ needed to be further investigated.The objective of this study was to determine the side effects.METHODS: The data of glioma patients treated with TMZ in West China Hospital were reviewed.Patients’ demographic characteristics,tumor grade,TMZ regimen,blood tests,blood biochemical tests,and adverse reactions were analyzed.The adverse reactions were assessed according to the criteria of drug toxicity,the NCI-CTC(common toxicity criteria) 3.0.RESULTS: A total of 123 patients were enrolled,with an age of 23-81 years(average 46 years).There were 65 males and 58 females.Eighty-one cases were diagnosed as high-grade gliomas in 81 cases,among whom 32 cases received concurrent chemoradiotherapy and 42 treated only with temozolomide.Forty-nine cases were low-grade gliomas.Hematologic toxicity was observed in 16 cases(13.0%),nausea and vomiting in 54 cases(44.3%),fatigue in 46 cases(37.4%),skin lesions in 6 cases(4.9%),and blurred vision in 8 cases(6.5%),respectively.Adverse reactions were more frequently observed in females and in cases with concurrent chemoradiotherapy.There is no relationship between tumor grade and adverse reactions.CONCLUSONS: Adverse reactions of TMZ are relatively minor,but occasional serious adverse reactions should be monitored closely.The incidence of adverse reactions in female patients,or in those who received concurrent chemoradiotherapy is higher.How to control the adverse reactions is still worth exploring.