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目的:评价间变性星形细胞瘤术后调强放疗同期联合替莫唑胺(TMZ)化疗的疗效及毒副作用。方法:57例间变性星形细胞瘤术后患者随机分成调强放疗同期TMZ化疗组和单纯调强放疗组,观察两组患者1、2、3年生存率和无进展生存期及毒副作用。对有病灶残留者观察近期疗效。Kaplan-Meier法计算生存率及χ2检验。结果:随访截止2012-02-20,2例失访,随访率96.5%(55/57)。放化疗同期组和单纯放疗组1年生存率分别为82.1%(23/28)和69.0%(20/29),差异无统计学意义,χ2=2.98,P=0.060;2年生存率分别为67.9%(19/28)和58.6%(17/29),差异有统计学意义,χ2=3.95,P=0.039;3年生存率分别为46.4%(13/28)和34.5%(10/29),χ2=4.28,P=0.033。放化疗同期组中位生存期32.6个月,单纯放疗组24.5个月,差异有统计学意义,χ2=3.89,P=0.042。放化疗同期组和单纯放疗组患者1年无进展生存率分别为78.6%(22/28)和65.5%(19/29),差异无统计学意义,χ2=3.20,P=0.058;2年无进展生存率为57.1%(16/28)和41.4%(12/29),差异有统计学意义,χ2=4.32,P=0.032;3年无进展生存率为32.1%(9/28)和24.1%(7/29),两组比较差异有统计学意义,χ2=4.18,P=0.041。有病灶残留者近期有效率放化疗同期组为70.0%(14/20),单纯放疗组为59.1%(13/22),差异有统计学意义,χ2=4.79,P=0.028。毒副作用较低,均为Ⅰ/Ⅱ级,主要表现为恶心、呕吐,白细胞、血小板下降,对症治疗后缓解。结论:间变性星形细胞瘤术后调强放疗同期联合TMZ化疗较单纯放疗能明显提高局部控制率、2、3年总生存率和无进展生存率,且毒副作用较小。
OBJECTIVE: To evaluate the efficacy and side effects of TKA combined with temozolomide (TMZ) chemotherapy in patients with anaplastic astrocytoma. Methods: Fifty-seven patients with anaplastic astrocytoma were randomly divided into two groups: TMZ chemotherapy with IMRT and IMRT. The 1, 2, 3 year survival rate, progression-free survival and toxicity were observed. To observe the short-term effects of residual lesions. Kaplan-Meier method to calculate survival rate and χ2 test. Results: As of the end of follow-up 2012-02-20, 2 cases were lost and the follow-up rate was 96.5% (55/57). The 1-year survival rates of radiotherapy and chemotherapy group and radiotherapy group were 82.1% (23/28) and 69.0% (20/29) respectively, with no significant difference (χ2 = 2.98, P = 0.060). The 2-year survival rates were The difference was statistically significant (χ2 = 3.95, P = 0.039). The 3-year survival rates were 46.4% (13/28) and 34.5% (10/29) ), χ2 = 4.28, P = 0.033. The median survival time was 32.6 months in radiotherapy and chemotherapy group and 24.5 months in radiotherapy alone group, the difference was statistically significant (χ2 = 3.89, P = 0.042). The 1-year progression-free survival rate was 78.6% (22/28) and 65.5% (19/29) in radiotherapy and chemotherapy group and radiotherapy alone group, respectively, with no significant difference (χ2 = 3.20, P = 0.058) The overall survival rate was 57.1% (16/28) and 41.4% (12/29) respectively, the difference was statistically significant (χ2 = 4.32, P = 0.032). The 3-year progression-free survival was 32.1% (9/28) % (7/29), the difference between the two groups was statistically significant, χ2 = 4.18, P = 0.041. There are 70% (14/20) patients in the same period of radiotherapy and chemotherapy group and 59.1% (13/22) in radiotherapy group, the difference is statistically significant (χ2 = 4.79, P = 0.028). Low side effects, are Ⅰ / Ⅱ grade, mainly for nausea, vomiting, leukopenia, thrombocytopenia, symptomatic relief after treatment. CONCLUSIONS: Anastomosing astrocytoma (TAM) combined with radiotherapy combined with TMZ after radiotherapy can significantly improve the local control rate, the overall and median survival rates, and the progression-free survival rate after 2 and 3 years, with less side effects.