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目的探讨替莫唑胺(TMZ)联合放射治疗治疗恶性脑胶质瘤的临床疗效和安全性评价。方法收集56例病理学诊断为恶性脑胶质瘤的患者,其中III级患者为32例,IV级患者为24例。根据不同的治疗方法将患者分为TMZ联合放疗(TMZ-RT)组(30例)和单纯放疗(RT)组(26例)。TMZ-RT组患者采用放疗联合TMZ化疗(75 mg·m-2·d-1)治疗6周,放疗后继续给予TMZ序贯/辅助(150~200 mg·m-2·d-1)化疗2~4周。RT组患者接受立体定向适形放射治疗1.8~3Gy/d,部分患者接受超分割放射治疗,总剂量为60~75 Gy。治疗结束后评估两组患者的生存率和近期疗效。结果影像学结果显示,TMZ-RT组完全缓解8例,部分缓解9例,稳定10例,进展3例;RT组完全缓解6例,部分缓解8例,稳定8例,进展4例,两组差异无统计学意义(P>0.05)。TMZ-RT组患者的1、2、3年生存率分别为86.7%、80.0%和56.7%。RT组患者的1、2、3年生存率分别为73.1%、30.8%和11.5%,两组患者的2年和3年生存率比较,差异有统计学意义(P<0.05)。TMZRT组和RT组患者的中位复发时间分别为(23.1±8.7)个月和(15.8±8.9)个月,两组差异有统计学意义(P<0.05)。TMZ-RT组和RT组患者化疗后KPS评分别为(89.8±9.7)分和(65.4±10.3)分,两组间差异有统计学意义(P<0.05)。TMZ-RT组患者的不良反应发生率较低且,患者的生活质量水平显著高于RT组患者(P<0.05)。结论 TMZ联合放疗与单纯放疗治疗恶性脑胶质瘤的近期疗效相当,但TMZ联合放疗能够显著提高2年和3年的生存率并延缓复发时间。TMZ联合放疗治疗不良反应轻,安全性高,能够改善患者的生活质量,值得临床进一步推广。
Objective To investigate the clinical efficacy and safety evaluation of temozolomide (TMZ) combined with radiotherapy in the treatment of malignant glioma. Methods Fifty-six patients with pathologically diagnosed malignant glioma were collected, of whom 32 were in class III and 24 in class IV. According to different treatment methods, patients were divided into TMZ combined radiotherapy (TMZ-RT) group (30 cases) and radiotherapy alone group (26 cases). Patients in TMZ-RT group were treated with radiotherapy combined with TMZ chemotherapy (75 mg · m-2 · d-1) for 6 weeks, followed by TMZ sequential / adjuvant chemotherapy (150-200 mg · m-2 · d-1) 2 to 4 weeks. RT patients received stereotactic stereotactic radiotherapy 1.8 ~ 3Gy / d, some patients underwent fractionated radiotherapy, the total dose of 60 ~ 75 Gy. After treatment, the survival and the short-term efficacy of the two groups were evaluated. Results The imaging results showed that the TMZ-RT group was completely relieved in 8 cases, partially relieved in 9 cases, stabilized in 10 cases and progressed in 3 cases. In the RT group, 6 cases were completely relieved, 8 cases partially relieved, 8 cases stable, 4 cases progressed, The difference was not statistically significant (P> 0.05). The 1-, 2- and 3-year survival rates of TMZ-RT patients were 86.7%, 80.0% and 56.7%, respectively. The 1, 2, 3-year survival rates of patients in RT group were 73.1%, 30.8% and 11.5%, respectively. There was significant difference in 2-year and 3-year survival rates between the two groups (P <0.05). The median time to relapse in patients with TMZRT and RT was (23.1 ± 8.7) months and (15.8 ± 8.9) months, respectively, with significant difference between the two groups (P <0.05). The KPS scores of TMZ-RT group and RT group after chemotherapy were (89.8 ± 9.7) and (65.4 ± 10.3) points, respectively, with significant difference between the two groups (P <0.05). In the TMZ-RT group, the incidence of adverse reactions was low and the quality of life of patients in the TMZ-RT group was significantly higher than that in the RT group (P <0.05). Conclusion TMZ combined with radiotherapy is similar to radiotherapy alone in the treatment of malignant gliomas. However, TMZ combined with radiotherapy can significantly improve the 2-year and 3-year survival rates and delay the relapse time. TMZ combined with radiotherapy treatment of adverse reactions, high safety, can improve the quality of life of patients, it is worth further clinical promotion.