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背景与目的:脑胶质瘤发病率高,预后差,寻找新的治疗方法成为这种疾病研究的热点。本研究通过前瞻性随机对照研究来观察三维适形放疗(3D-CRT)联合替莫唑胺同步化疗治疗脑胶质瘤术后残留患者的临床疗效。方法:62例术后有残留的脑胶质瘤患者前瞻性分组:单纯三维适形放疗(单放组)及三维适形放疗加同步化疗(放化组),各31例。两组均接受三维适形放疗,6MV-X射线,2.0Gy/f,1次/天,5次/周,处方剂量50～60Gy/5～6周。放化组加用替莫唑胺75mg/(m2·d),从放疗第1天开始口服到放疗结束,随后继续给予替莫唑胺150～200mg/(m2·d),治疗5d,每28d为1个周期,共3～6个周期。结果:单放组总有效率35.5%(11/31),放化组61.3%(19/31),统计学差异显著(P=0.042);两组生存比较无统计学差异(P=0.263)。分层分析显示:病理Ⅲ级脑胶质瘤同步放化疗生存优于单纯放疗组(P=0.043)。结论:病理Ⅲ级脑胶质瘤术后三维适形放疗联合同步化疗,可以取得较单纯三维适形放疗更好的疗效。
BACKGROUND & OBJECTIVE: The incidence of glioma is high and the prognosis is poor. Looking for new treatments has become a hot spot in this disease research. This study prospective randomized controlled study to observe the clinical efficacy of three-dimensional conformal radiotherapy (3D-CRT) combined with temozolomide concurrent chemotherapy in the treatment of residual glioma patients. Methods: Sixty-two patients with residual glioma after surgery were prospectively divided into three-dimensional conformal radiotherapy (single radiotherapy group) and three-dimensional conformal radiotherapy plus concurrent chemotherapy (radiotherapy group), with 31 cases in each group. Both groups received three-dimensional conformal radiotherapy, 6MV-X-ray, 2.0Gy / f, once a day, 5 times a week, the prescription dose of 50 ~ 60Gy / 5 ~ 6 weeks. The radiotherapy group was given temozolomide 75 mg / (m2 · d) orally from the first day of radiotherapy to the end of radiotherapy, and then continued to receive temozolomide 150 ~ 200 mg / (m2 · d) for 5 days, one cycle every 28 days. 3 ~ 6 cycles. Results: The total effective rate was 35.5% (11/31) in radiotherapy group and 61.3% (19/31) in radiotherapy group, with significant difference (P = 0.042). There was no significant difference between the two groups (P = 0.263) . Stratified analysis showed that the survival rate of pathological grade III glioma was better than radiotherapy group (P = 0.043). Conclusion: Three-dimensional conformal radiotherapy combined with concurrent chemotherapy after pathological grade III glioma can achieve better curative effect than simple three-dimensional conformal radiotherapy.