目的 替莫唑胺是一种新型烷化剂,因其口服给药、生物利用度好、良好的血脑屏障通透性以及突出的治疗效果,已成为恶性脑胶质瘤治疗的常规用药.本文旨在通过对替莫唑胺的不良反应的研究,以期最大限度地减轻药物的不良反应,提高患者的生存质量.方法 根据2009年美国卫生与公共服务部制定的药物常见不良事件评价标准第四版(CTCAE-V4.0),观察使用替莫唑胺联合放射治疗的同步放化疗和化学治疗患者所出现的化疗不良反应,并采取积极的防治措施进行处理.结果 本组95例接受替莫唑胺联合同步放化治疗的患者中,严格依据CTCAE-V4.0评价原则,得出结果如下:有20例患者出现胃肠道不良反应,其中1级的有12例,2级有8例.发生1级中性粒细胞减少的为6例,2级的为3例；1级血小板减少者3例,2级的为1例.发生脱发者为53例,1级的有41例,2级有12例.发生皮疹、斑丘疹共7例,1级的为6例,2级的为1例.所有上诉不良反应较轻,标准均为1-2级,无3、4、5级不良反应发生.在给予对症、停药处理后均能明显缓解.结论 替莫唑胺是目前胶质瘤治疗的常用药物,通过对替莫唑胺联合放射治疗过程中的不良反应,显示其不良反应较轻微,且给予对症处理后均能明显缓解.因此,在对恶性脑胶质瘤患者使用同步放射治疗化学治疗中,替莫唑胺的应用是安全的.%Objective Radiotherapy has been of key importance to the treatment of malignant gliomas fox decades, and the ability to focus the beam and tailor it to the irregular contours of brain tumors and minimize the dose to nearby critical structures with intensity modulated or image-guided techniques has improved greatly. Temozolomide, an alkylating agent given in simple oral route of administration, is used in conjunction with and after radiotherapy. This study aimed to evaluate the toxic effects of temozolomide when used incombination with radiotherapy, to observe the side effects of temozolomide, evaluate the clinical safety of the drug, and improve the quality of life in patients with glioma. Methods Based on the Common Terminology Criteria forAdverse Events ( CTCAE ) Version 4.0, the authors observed the toxicity of temozolomide in patients with concurrent chemoradiotherapy, and take active measures to deal with the toxicity. Results here were 95 patients who received concurrent chemoradiotherapy, 20 patients had the symptoms of nausea, vomiting and loss of appetite, according to CTCAE-V4. 0, 12 cases were grade 1, 8 cases were grade 2. 9 patients had neutropenia, 6 of them were grade 1, 3 cases were grade 2. In the aspect of thrombocytopenia, 3 cases were grade 1, 1 case was grade 2. Mucocutaneous adverse reactions were observed in 7 cases, 6 cases were grade 1, 1 case was grade 2. One patient had symptoms of palpitation, the evaluation was grade 2. All patients had mild symptoms of adverse drug reactions, but the symptoms could significantly relieve after symptomatic treatment and withdrawal of the treatment. Conclusion Temozolomide is commonly used in the treatment of malignant glioma, the toxic and side effects were observed during the process of concurrent chemoradiotherapy, the toxic and side effects were minor, and can be relieved obviously after symptomatic treatment. Therefore, temozolomide is a safe drug for malignant glioma treatment.
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