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背景与目的:目前国内还没有一个统一的胶质瘤治疗规范。临床经常见到各种治疗上存在缺陷的脑胶质瘤患者,其生存期和生存质量较差。本文旨在分析总结脑胶质瘤患者治疗中存在的缺陷及其原因,为临床治疗提供参考。方法:收集自2000年1月至2006年3月期间在中山大学肿瘤防治中心门诊及住院诊治的有完整病案记录、有完整随访资料和有明确病理诊断的脑胶质瘤患者的资料。参照2005年美国NCCN(NationalCompressiveCancerNetwork)的诊疗规范,以及中山大学肿瘤防治中心脑胶质瘤单病种诊疗指引(2006),共收集82例治疗有缺陷的胶质瘤患者的资料,用Kaplan-Meier法来评估患者术后的生存状况,同时分析造成治疗缺陷的原因。结果:低级别胶质瘤中位无疾病进展生存时间为33个月,高级别胶质瘤中位无疾病进展生存时间为13个月;低级别胶质瘤中位生存时间为42个月,高级别胶质瘤中位生存时间为23个月。各种治疗缺陷的胶质瘤患者治疗后KPS评分明显下降。各种治疗缺陷以因患者原因导致手术后需要而未行放化疗的患者最多,共24例,占29.3%;其次为因医生原因导致的应该而未行化疗的患者,共18例,占22.0%;然后为因医生原因导致手术后需要而未行放化疗者、术后未行普通放疗而先行γ-刀治疗及因患者原因术后化疗而未行放疗者,各7例,分别占8.5%。结论:目前在脑胶质瘤的临床实践中有众多胶质瘤患者治疗存在缺陷,其中主要是因医生或/和患者原因导致的手术后应该而未行常规放疗及系统化疗的患者。所以在神经肿瘤医生中强调对胶质瘤的规范治疗意识十分迫切。
Background and Objective: At present, there is not a unified treatment standard for glioma in China. Clinical often see a variety of treatment defects in glioma patients, its survival and quality of life is poor. This article aims to analyze and summarize the existing defects and their causes in patients with glioma and provide reference for clinical treatment. Methods: From January 2000 to March 2006 during the period of Sun Yat-sen University Cancer Center outpatient and inpatient diagnosis and treatment of a complete record of medical records with complete follow-up data and clear pathological diagnosis of glioma patients. With reference to the 2005 National NCCN Guidelines for Treatment and Treatment of Gliomas and the Guideline for Diagnosis and Treatment of Glioma Single Disease in Sun Yat-sen University Cancer Center (2006), a total of 82 patients with glioma were collected. Kaplan-Meier France to assess the survival of patients after surgery, while analyzing the causes of treatment defects. Results: The median progression-free survival of patients with low-grade gliomas was 33 months. The median progression-free survival of high-grade gliomas was 13 months. The median survival time of low-grade gliomas was 42 months. The median survival time of high-grade glioma was 23 months. Patients with various treatment deficiencies of glioma significantly decreased KPS scores after treatment. A total of 24 patients (29.3%) were treated with various kinds of treatment defects due to the patient’s need but did not receive chemoradiation after surgery. Followed by doctors, 18 patients (22.0%) should be treated without chemotherapy %; And then because of medical reasons lead to surgery after the need for radiotherapy and chemotherapy, postoperative radiotherapy without prior γ-knife treatment and patients due to postoperative chemotherapy without radiotherapy, the seven cases, accounting for 8.5 %. CONCLUSIONS: Currently, there are many deficiencies in the treatment of glioma patients in clinical practice of gliomas, mainly those patients who should have undergone conventional radiotherapy and systemic chemotherapy after surgery due to doctors and / or patients. Therefore, it is urgent to emphasize the standard treatment of glioma in neuro-oncologists.