替莫唑胺胶囊治疗恶性脑胶质瘤30例疗效分析

目的评价替莫唑胺胶囊（TMZ）治疗人脑恶性胶质瘤的临床疗效及不良反应。方法2005年1月至2008年1月对一个单位30例术后确诊的恶性脑胶质瘤且使用TMZ化疗的患者进行随访，观察近期治疗反应、生存期，并分析常规病理和分子病理对治疗效果的影响。结果TMZ治疗结束时，30例患者客观有效率和疾病控制率分别为53．3％和80．0％，O^6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）对近期疗效无明显影响（P〉0．05），而不同病理类型的近期疗效存在明显差异（P〈0．05）。随访期间共有12例患者死亡，生存期为0．7～3．7年，中位生存期为1．5年。MGMT阳性和阴性患者的中位生存期分别为1．3年和1．5年，无明显差异（P：0．31）。胶质母细胞瘤和间变型星形细胞瘤的中位生存期分别为1．3年和2．0年，亦无明显差异（P=0．28）。不良反应包括厌食、便秘等消化道症状11例（36．7％），白细胞减少3例（10．0％），假性进展2例（6．7％）。结论TMZ对恶性胶质瘤患者有较好的临床疗效，不良反应少，耐受性好，治疗方案简便，是一种理想的恶性胶质瘤术后辅助化疗药物。

Effect of temozolomide in treatment of 30 patients with malignant gliomas

Objective To evaluate the efficacy and adverse reactions of temozolomide （TMZ） in the treatment of human brain malignant gliomas. Methods From January 2005 to January 2008, 30 patients of postoperative pathological confirmed malignant gliomas in one unit underwent chemotherapy with TMZ. The treatment response and survival time were studied, and the impact of routine pathology and molecular pathology on the efficacy of TMZ treatment was also analyzed. Results At the end of the full course of TMZ treatment, total objective response rate was 53.3% and disease control rate was 80%. 06-methylguanine- DNA methltransferase （MGMT） had no significant impact on short-term efficacy （ P 〉 0.05 ）, and there were significant differences in short-term efficacy of patients among different pathological types （P 〈 0.05）. A total of 12 patients died during the follow-up. The overall survival period was 0.7 - 3.7 years, and median survival time was 1.5 years. The median survival time of MGMT-positive and MGMT-negative patients was 1.3 years and 1.5 years, respectively. There was no significant difference in two groups （P =0.31 ）. The median survival time of patients with glioblastoma multiforme and with anaplastic astrocytoma was 1.3 years and 2.0 years, and there was also no significant difference （ P = 0.28 ）. The main adverse reactions included 11 cases of gastrointestinal symptoms （36.7%）, 3 cases of leukopenia （ 10.0% ）, and 2 cases of pseudo-progress （6. 7% ）. Conclusion Treatment of malignant gliomas with TMZ has better clinical efficacy and less adverse reactions. It is well tolerated and is an ideal drug of postoperative adjuvant chemotherapy for malignant glioma.