高危低级别胶质瘤放疗联合替莫唑胺与单纯放疗临床观察

目的 观察替莫唑胺联合放疗在高危低级别脑胶质瘤术后患者中的临床疗效和安全性。 方法 收集蚌埠医学院第一附属医院2015年1月—2018年1月收治的62例高危Ⅱ级脑胶质瘤术后患者的临床资料,患者全部采用术后精确调强放疗。按术后是否口服替莫唑胺将患者分为2组,观察组32例患者放疗期间接受同步化疗,从第1天放疗开始接受替莫唑胺75 mg/m2口服化疗,放疗结束后每4周辅助口服替莫唑胺150~200 mg/m2化疗,每周期5 d,连续6个周期;对照组30例患者仅接受术后放疗。观察比较2组患者在治疗期间的不良反应,治疗前后认知功能变化情况,1、2年无进展生存率和总生存率。 结果 治疗期间的主要不良反应表现为骨髓抑制、胃肠道反应、头痛,2组比较差异无统计学意义(均P>0.05)。治疗前2组认知功能比较无明显差异(P>0.05),治疗后观察组患者认知功能未发生明显改变(P>0.05),对照组中有部分患者存在认知功能下降,差异有统计学意义(P<0.05)。观察组1、2年无进展生存率分别为93.8%、81.2%,对照组1、2年无进展生存率分别为66.7%、53.3%,2组比较差异有统计学意义(均P<0.05)。观察组1、2年总生存率分别为93.8%、84.4%,对照组1、2年总生存率分别为70.0%、60.0%,2组比较差异有统计学意义(均P<0.05)。 结论 替莫唑胺联合术后精确调强放疗治疗高危低级别脑胶质瘤患者的不良反应经过对症处理后可明显缓解,安全性良好,能够有效改善患者的认知功能,提高患者的生活质量,可明显延长患者的生存期。 

Clinical observation of radiotherapy combined with temozolomide and radiotherapy alone for high-risk low-grade glioma

Objective To observe the clinical efficacy and safety of temozolomide combined with radiotherapy in patients with high-risk low-grade glioma after surgery. Methods The clinical data of 62 patients with high-risk grade Ⅱ glioma treated in our hospital from January 2015 to January 2018 were collected. All patients were treated with postoperative intensity-modulated radiotherapy. The observation group(32 patients) received concurrent chemotherapy during radiotherapy, and received temozolomide 75 mg/m2 oral chemotherapy from the first day of radiotherapy, and then received oral temozolomide 150-200 mg/m2 chemotherapy every four weeks after radiotherapy, 5 days a week for 6 consecutive cycles, meanwhile the control group(30 patients) only received postoperative radiotherapy. Adverse reactions, changes of cognitive function before and after treatment, 1, 2-year progression free survival rate and overall survival rate were observed and compared between the two groups. Results The main adverse reactions during the treatment were myelosuppression, gastrointestinal reaction and headache. There was no significant difference between the two groups(all P>0.05). There was no significant difference in cognitive function between the two groups before treatment(P>0.05). There was no significant change in cognitive function in the observation group after treatment(P>0.05), in the control group, there were some patients with cognitive decline, and the difference was statistically significant(P<0.05). The 1-year and 2-year progression free survival rates of the observation group were 93.8% and 81.2% respectively, and the 1-year and 2-year progression free survival rates of the control group were 66.7% and 53.3%, respectively, and the difference between the two groups was statistically significant(all P<0.05). The 1-year and 2-year overall survival rates of the observation group were 93.8% and 84.4% respectively, and the 1-year and 2-year overall survival rates of the control group were 70.0% and 60.0%, respectively, and the difference was statistically significant(all P<0.05). Conclusion The adverse reactions of temozolomide combined with postoperative precise intensity-modulated radiotherapy in the treatment of high-risk low-grade glioma patients can be significantly alleviated after symptomatic treatment, with good safety, which can effectively improve the cognitive function of patients, improve the quality of life of patients, and significantly extend the survival period of patients.