Objective To evaluate the efficacy and safety of temozolomide ( TMZ ) combined with concomitant 3 - Dimension conformal radiotherapy ( 3D - CRT ) in treatment of postoperative patients with malignant intracranial glioma. Methods 28 postoperative patients with malignant glioma confirmed by pathology were randomly divided into two groups ( control group and treatment group ), with each group 14 cases. The patients of treatment group received four to six cycles of temozolomide combined with 3D - CRT, with each cycle 28 days. The control group cases only received radiotherapy. The approach and dose of radiotherapy for each group were the same. After treatment, all patients followed up periodically. The efficacy, median recurrent time, survival rate, life quality and medicine safety were analyzed. Results Whole - brain CT or MRI showed that in treatment group, with 3 cases completely relieved, 4 cases partly relieved, 5 cases stahilized, 2 cases aggravated. In control group , with 2 cases completely relieved , 2 cases partly relieved, 7 cases stabilized and 3 cases aggravated. There was no statistically significant difference between the two groups ( P ＞0. 05 ). Median recurrent time was 21 months in treatment group and 17 months in control group ( P ＜ 0. 05 ); The 1, 2, 3 years survival rates were 85. 7％ ( 12/14 ), 78. 6％ ( 11/14 ) and 57. 1％ ( 8/14 ) in treatment group and 71. 4％ ( 10/14 ), 35. 7％ ( 5/14 ) and 14. 3％ ( 2/14 ) in the control group. There were significant differences in 2, 3 years survival rates and median re.current time between the two groups ( P ＜ 0. 05 ). The main side effects in treatment group were nausea, vomiting, myelosuppression and headache ( grade Ⅰ ～Ⅱ ), the incidence was low.Symptomatic treatment for these side effects did not affect the treatment of glioma. The improvement of life quality in treatment group was significantly better than that of control group. Conclusion Three - dimension conformal radiotherapy combined with temozolomide is not more effective than radiotherapy alone in postoperative malignant glioma in the near future, but can improve the 2, 3 years survival rates with slight side effects , and it can significantly improve the quality of life.%目的 探讨三维适形放疗联合替莫唑胺(temozolomide,TMZ)治疗恶性脑胶质瘤术后患者的疗效和安全性.方法 选择经病理证实的恶性脑胶质瘤术后患者共28例,随机分为观察组和对照组,各14例.观察组在适形放疗的同时采用TMZ化疗,28 d为一个疗程,每例患者进行4～6个疗程的治疗;对照组仅行单纯适形放疗,两组患者放疗方法及剂量相同.所有患者治疗结束后定期随访,进行实体肿瘤客观疗效、中位复发时间、生存率、生活质量和药物安全性的评定.结果 脑增强CT或MRI示实体肿瘤治疗后观察组完全缓解3例、部分缓解4例、稳定5例、病变进展2例;对照组完全缓解2例、部分缓解2例、稳定7例、病变进展3例,两组患者的近期疗效间差异无统计学意义(P＞0.05);治疗组1、2、3年生存率分别为85.7%(12/14)、78.6%(11/14)和57.1%(8/14),对照组分别为71.4%(10/14)、35.7%(5/14)和14.3%(2/14);观察组中位复发时间为(22.8±8.9)个月,对照组中位复发时间为(16.3±10.4)个月,两组2、3年生存率及中位复发时间比较,差异均有统计学意义(P＜0.05).观察组常见不良反应有恶心、呕吐、头痛及骨髓抑制等,发生率低,且仅限于I、II级,经对症治疗后未影响治疗,观察组患者生活质量的改善情况明显优于对照组.结论 放疗联合口服TMZ治疗恶性脑胶质瘤术后患者其近期疗效与单纯放疗的疗效相当,但其能延缓中位复发时间,提高2、3年生存率;不良反应轻微,能明显改善患者生活质量.
展开▼
