成人Ⅱ级以上脑胶质瘤术后同步放化疗疗效分析

 目的 前瞻性研究成人Ⅱ级以上脑胶质瘤患者术后同步放化疗的疗效。方法 1999年9月～2003年5月收治80例成人Ⅱ级以上脑胶质瘤术后患者,随机分成两组,各40例。①单纯放疗组,行单纯放疗,DT50～60Gy;②同步放化疗组,给予与单纯放疗组相同的放疗方法,同时于DT20Gy后行同步替尼泊甙（VM-26）联合司莫司汀（Me-CCNU）化疗,于放疗开始后4～6个月内完成4～6周期化疗。结果 后同步放化疗组1、3、5年生存率分别为85.00%、52.50%、30.00%,优于术后单纯放疗组的62.50%、27.50%、15.00%（χ²=5.07,P=0.024）。按不同病理分级进行比较,Ⅲ级脑胶质瘤同步放化疗的生存率明显优于单纯放疗（χ²=3.96,P=0.047）,而Ⅱ级和Ⅳ级脑胶质瘤上述两种疗法的生存率无差异。结论 成人Ⅲ级脑胶质瘤患者术后外照射20Gy后行同步MV方案化疗,预后优于术后单纯放疗;对于Ⅳ级脑胶质瘤患者,其术后化疗方法以及放化疗结合方式仍需要探讨;成人Ⅱ级脑胶质瘤术后可以不必给予放化疗联合治疗。

Effect of Postoperative Radiotherapy Concurrent Chemotherapy on Adult Patients with Grade Ⅱ～Ⅳ Cerebral Gliomas

Objective 　To prospectively study the survival of adult patients with grade Ⅱ～ Ⅳcerebral gliomas received radiochemotherapy postoperatively. Methods 　From sept . 1999 to may 2003 , 80 adult postoperative patients with grade Ⅱ～ Ⅳcerebral gliomass were treated and divided into two groups randomly ,each had 40 cases. One group (RT group) was irradiated with DT50～60 Gy merely and the other (RCT group) combined with chemotherapy(VM-26 and Me-CCNU) after DT20 Gy and 4～6 cycles of chemotherapy were delivered within 4～6 months. Results 　The 1- , 3- , and 5- year survival rate of patients of RCT group was 85. 00 %、52. 50 %、30. 00 % while the survival rate of RT group was 62. 50 %、27. 50 %、15. 00 %, respectively. The difference of the survival rates between two groups was significant (χ² = 5. 07 , P = 0. 024) . Based on pathological grades , however ,it was suggested that only the patients with grade Ⅲgliomas of RCT group had better prognosis than ones of RT group (χ² = 3. 96 , P = 0. 047) . The similar results were not found in patients with grade Ⅱor Ⅳgliomas. Conclusion 　Given concurrent radiochemotherapy postoperatively , the survival could be improved in adult patients with grade Ⅲgliomas. And the data suggested that VM-26 combined with Me-CCNU should be an effective chemotherapeutic scheme. AS to grade Ⅳgliomas , more novel chemotherapeutic methods shoud be studied. The patients with grade Ⅱgliomas needn’t receive chemotherapy besides postoperative radiotherapy.