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目的:前瞻性观察尼妥珠单抗联合再程放疗治疗复发性高分级胶质瘤患者的疗效和不良反应。方法:2008年10月—2011年3月,10例复发性高分级胶质瘤患者接受再程常规分割放射治疗。首程放疗与再程放疗间隔时间为7～42个月,中位时间为20个月。再程放疗剂量为40～51Gy(18～27fx),26～40d;中位剂量为48Gy(24fx),35d。放疗期间,每周静脉滴注尼妥珠单抗1次,共3～6次。记录不良反应和近期疗效,计算总生存率和无进展生存率。结果:急性反应主要是Ⅰ～Ⅱ级头痛、消化系统反应和神经功能障碍加重,经对症治疗可明显缓解,未发现Ⅲ级以上急性不良反应。有3例患者发生放射性脑坏死。10例患者中,部分缓解3例,疾病稳定6例,疾病进展1例;KPS评分提高4例、不变4例、下降2例。中位疾病进展时间为6.5个月,6个月和1年无进展生存率分别为60%和20%;中位生存时间为11.5个月,6个月和1年总生存率分别为80%和50%。结论:尼妥珠单抗联合再程放疗治疗复发性高分级胶质瘤患者有效而安全,对长期疗效还有待进一步随访。
OBJECTIVE: To prospectively observe the efficacy and adverse reactions of nimotuzumab combined with reradiation in the treatment of patients with recurrent high grade gliomas. Methods: From October 2008 to March 2011, 10 patients with recurrent high grade gliomas underwent conventional radiotherapy. The first course of radiotherapy and re-radiation treatment interval of 7 to 42 months, the median time was 20 months. Radiotherapy dose was 40 ~ 51Gy (18 ~ 27fx), 26 ~ 40d; median dose was 48Gy (24fx), 35d. During radiotherapy, nimotuzumab was administered intravenously once a week for 3 to 6 times. Adverse reactions and short-term efficacy were recorded and the overall survival rate and progression-free survival rate were calculated. Results: The acute reactions were mainly grade Ⅰ ~ Ⅱ headache, digestive system reactions and neurological dysfunction increased significantly after symptomatic treatment can be significantly alleviated, no grade Ⅲ or more acute adverse reactions were not found. Three patients developed radioactive brain necrosis. Among the 10 patients, 3 were partly relieved, 6 were stable, 1 were advanced. KPS scores increased by 4, unchanged by 4, and decreased by 2. The median progression time was 6.5 months, and the 6-month and 1-year progression-free survival rates were 60% and 20%, respectively; the median survival time was 11.5 months, and the 6-month and 1-year overall survival rates were 80% And 50%. CONCLUSION: Nepalezizumab combined with RT-PCR is effective and safe in the treatment of patients with recurrent high grade gliomas. Long-term therapeutic effect remains to be followed up.