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目的研究同步加量调强放疗(SIB-IMRT)联合替莫唑胺化疗治疗脑胶质母细胞瘤术后残留的临床效果。方法对56例脑胶质母细胞瘤术后残留患者行SIB-IMRT,靶区勾画:残留病灶勾画为GTV,外放5 mm为临床靶区(CTV),CTV外放5 mm为计划靶区(PTV);瘤床勾画为临床靶区(CTV1),CTV1分别外放15 mm和30 mm为计划靶区1(PTV1)和计划靶区2(PTV2),PTV、PTV1、PTV2处方量分别为2.5 Gy/次、2.3 Gy/次、2.0 Gy/次,5次/周,共25次;放疗期间每日口服替莫唑胺75 mg/m2。同步放化疗结束后,继续给予替莫唑胺150 mg/m2,连续口服5 d,28 d为1个周期,辅助化疗共6个周期。56例患者单纯行同步放化疗者26例为A组,放化疗结束后继续化疗6个周期者30例为B组。结果全组56例患者中CR 7例(12.5%),PR 38例(67.8%),SD 8例(14.3%),PD 3例(5.4%);全组患者的有效率80.3%。全组平均生存时间为(29.82±9.11)月;1年、2年、3年生存率分别为96.4%、73.2%、33.9%;A组与B组比较平均生存时间、生存曲线差异均有统计学意义(Ρ﹤0.001)。放化疗的不良反应较轻,毒性反应以血液学毒性为主。结论同步加量调强放疗联合替莫唑胺化疗加后续单药辅助化疗治疗脑胶质母细胞瘤术后残留患者有较好的临床效果,不良反应可耐受,建议临床推广应用。
Objective To study the clinical effect of SIB-IMRT combined with temozolomide chemotherapy in the treatment of residual brain glioblastoma. Methods Fifty-six patients with brain glioblastoma were treated with SIB-IMRT. The target area was delineated. The residual lesions were characterized by GTV, 5 mm external fixation (CTV) and 5 mm CTV external target area (PTV). The tumor bed was outlined as CTV1, and CTV1 was 15 mm and 30 mm respectively for PTV1 and PTV2. The prescriptions of PTV, PTV1 and PTV2 were 2.5 Gy / time, 2.3 Gy / time, 2.0 Gy / time, 5 times / week, a total of 25 times; daily oral administration of temozolomide 75 mg / m2. After concurrent chemoradiation, temozolomide was given continuously at a dose of 150 mg / m2 for 5 consecutive days and 28 days for 1 cycle. Adjuvant chemotherapy was given for 6 cycles. Sixty-six patients were treated with concurrent radiochemotherapy alone in 26 patients, and 30 patients in group B received chemotherapy after 6 cycles of chemoradiotherapy. Results Among the 56 patients, CR was 7 (12.5%), PR 38 (67.8%), SD 8 (14.3%) and PD 3 (5.4%). The overall effective rate was 80.3%. The average survival time of the whole group was (29.82 ± 9.11) months. The 1-year, 2-year and 3-year survival rates were 96.4%, 73.2% and 33.9% respectively. The average survival time and the survival curves of group A and group B were statistically different Significance (P <0.001). Adverse reactions to chemotherapy and radiotherapy lighter, toxic reactions based on hematological toxicity. Conclusions Simultaneous dose-plus-dose RT combined with temozolomide plus single-drug adjuvant chemotherapy in the treatment of residual glioblastoma patients has good clinical results, adverse reactions are tolerable, and it is recommended for clinical application.