成人脑恶性胶质瘤术后两种同步放化疗方案的疗效比较

目的比较成人脑恶性胶质瘤患者进行术后放疗同步替莫唑胺(TMZ)治疗与同步替尼泊甙(VM-26)联合司莫司汀(Me-CCNU)化疗的疗效差异。方法 96例18周岁以上恶性胶质瘤患者,均经手术肉眼全切或部分切除肿瘤,Karnofskv评分60分以上,随机分为两组:实验组(TMZ-RT组)和对照组(VM-RT组),每组各48例。(1)TMZ-RT组:放疗同步TMZ治疗组;(2)VM-RT组:放疗同步VM方案化疗组。观察实验组和对照组骨髓抑制、消化道反应、急性放射性脑损伤发生率,以及两组患者即期疗效、中位生存时间和1、2、3年总生存率。结果两组患者观察期内均未出现Ⅲ度以上毒性反应,TMZ-RT组的Ⅰ～Ⅱ度不良反应发生率较VM-RT组为低(P<0.05)。TMZ-RT组治疗有效率明显好于VM-RT组(JP<0.05)。TMZ-RT组的中位生存期为28个月,1、2、3年生存率分别为72.9%、54.2%、31.3%,优于VM-RT组的16个月及62.5%、33.3%、16.7%(P<0.05)。结论成人脑恶性胶质瘤术后放疗同步TMZ化疗疗效较好,毒副作用亦较轻,TMZ口服应用方便,有较好的临床应用前景。

Comparison of two regimens of postoperative concurrent chemoradiotherapy in adult patients with grade III-IV cerebral gliomas

Objective To compare the therapeutic efficacy of two regimens of postoperative radiotherapy with concurrent chemotherapy using temozolomide(TMZ) and teniposide(VM-26) plus semustine(Me-CCNU) in adult patients with gradeⅢ-Ⅳcerebral gliomas.Methods Ninety-six adult postoperative patients with gradeⅢ-Ⅳcerebral gliomas were randomized into two groups(n=48) to receive 60 Gy radiotherapy with concurrent TMZ treatment(TMZ-RT group) and radiotherapy with VM-26 plus Me-CCNU treatments(VM-RT group).The adverse effects of marrow depression,gastrointestinal toxicity and acute radiation-induced brain injury were observed.The immediate effect and survival outcome of the patients were compared between the two groups.Results No adverse effects beyond gradeⅢwere observed in the two groups.TMZ-RT group showed a significantly lower incidence of gradeⅠ-Ⅱadverse effects than VM-RT group(P<0.05).The median survival time and 1-,2-,and 3-year survival rates of the patients in TMZ-RT group were 28 months,72.9%,54.2%and 31.3%,respectively, showing significant differences from those in VM-RT group(16 months,62.5%,33.3%and 16.7%,respectively,P<0.05). Conclusion Radiotherapy with concurrent TMZ chemotherapy is an effective regimen with mild toxicities for treatment of adult malignant cerebral glioma.