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目的:观察放疗联合替莫唑胺(TMZ)同步治疗恶性胶质瘤的疗效。方法:62例手术后恶性胶质瘤患者随机分成放疗联合TMZ同步治疗组(治疗组)和放疗联合替尼泊甙(VM-26)+甲环亚硝脲(Me-CCNU)组(对照组)。治疗组30例(3级21例,4级9例),对照组32例(3级24例,4级8例)。头颅常规放疗DT60Gy/30f/42d,治疗组同时每天服用TMZ75mg/m2,直到放疗结束。随后用TMZ辅助化疗6疗程,150～200mg/(m2.d)×5d,每28天重复。对照组放疗后VM-2670mg/(m2.d)×3天,Me-CCNU100～150mg/(m2.d)×1天,每28天重复,连用6疗程。结果:治疗组1、2、3年生存率分别是73.3%(22/30)、33.3%(10/30)、6.7%(2/30),中位生存期20个月。对照组1、2、3年生存率分别是68.8%(22/32)、28.1%(9/32)、6.3%(2/32),中位生存期17个月。两组比较无显著差异(P>0.05)。两组血液学毒性和放射性脑损伤症状可耐受。结论:放疗联合TMZ化疗提高了恶性胶质瘤的生存率,与放疗联合VM-26+Me-CCNU化疗相比,生存率差异无统计学意义。
Objective: To observe the curative effect of radiotherapy combined with temozolomide (TMZ) in the simultaneous treatment of glioblastoma. Methods: Sixty-two patients with malignant glioma after operation were randomly divided into radiotherapy combined with TMZ synchronous therapy (treatment group) and radiotherapy combined with VM-26 and Me-CCNU (control group ). There were 30 cases in the treatment group (21 cases in grade 3 and 9 cases in grade 4) and 32 cases in control group (24 cases in grade 3 and 8 cases in grade 4). Skull conventional radiotherapy DT60Gy / 30f / 42d, the treatment group taking TMZ75mg / m2 every day, until the end of radiotherapy. Followed by TMZ adjuvant chemotherapy 6 courses, 150 ~ 200mg / (m2.d) × 5d, repeated every 28 days. The control group after VM-2670mg / (m2.d) × 3 days, Me-CCNU100 ~ 150mg / (m2.d) × 1 day, repeated every 28 days, once every 6 courses. Results: The 1, 2, 3 year survival rates were 73.3% (22/30), 33.3% (10/30) and 6.7% (2/30) in the treatment group, respectively. The median survival time was 20 months. The 1, 2, 3-year survival rates of control group were 68.8% (22/32), 28.1% (9/32), 6.3% (2/32), respectively. The median survival time was 17 months. There was no significant difference between the two groups (P> 0.05). Hematological toxicity and radiation brain injury symptoms were tolerable in both groups. Conclusion: Radiotherapy combined with TMZ chemotherapy can improve the survival rate of malignant glioma. Compared with radiotherapy and VM-26 + Me-CCNU chemotherapy, there is no significant difference in survival rate.