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目的探讨三维适型放射治疗结合替莫唑胺治疗弥漫性脑干胶质瘤的临床疗效。方法选择2006年1月—2010年1月在我院住院治疗的弥漫性脑干胶质瘤患者21例,根据治疗方法分为单纯放疗组9例,放化疗同步组12例。单纯放疗组采用三维适型放射治疗,放化疗同步组采用三维适型放射治疗结合替莫唑胺化疗。观察两组生活质量评分(KPS评分)、毒副作用,随访患者生存时间(治疗开始至死亡)。结果治疗前,单纯放疗组KPS评分为(68.3±5.0)分,放化疗同步组为(69.2±6.3)分,差异无统计学意义(t=0.053,P>0.05)。治疗6个月后单纯放疗组KPS评分为(66.7±24.5)分,放化疗同步组为(76.7±13.0)分,差异有统计学意义(t=5.039,P<0.05)。化疗毒副作用主要是恶心呕吐等消化系统反应,偶见头痛、皮疹和血细胞减少,均属Ⅰ~Ⅱ级,经对症治疗后症状明显减轻或消失,无Ⅲ级及以上毒副作用。随访3年,死亡18例,存活3例。单纯放疗组和放化疗同步组中位生存时间分别为19个月和26个月,差异有统计学意义(P=0.009)。单纯放疗组1年和2年生存率分别为77.8%和11.1%,放化疗同步组1年和2年生存率分别为83.3%和50.0%。结论三维适型放射治疗结合替莫唑胺化疗可明显改善弥漫性脑干胶质瘤患者生活质量,延长生存期,具有良好的应用前景。
Objective To investigate the clinical efficacy of three-dimensional conformal radiotherapy combined with temozolomide in the treatment of diffuse brain stem glioma. Methods Twenty-one patients with diffuse brain stem glioma who were hospitalized in our hospital from January 2006 to January 2010 were divided into 9 cases of radiotherapy alone and 12 cases of radiotherapy and chemotherapy simultaneously. Radiotherapy alone group using three-dimensional conformal radiotherapy, radiotherapy and chemotherapy synchronization group using three-dimensional conformal radiotherapy combined with temozolomide chemotherapy. The quality of life score (KPS), side effects and survival time of patients (treatment start to death) were observed. Results Before treatment, KPS score was (68.3 ± 5.0) in radiotherapy alone group and (69.2 ± 6.3) in radiotherapy and chemotherapy group, with no significant difference (t = 0.053, P> 0.05). After 6 months of treatment, the KPS score of the radiotherapy group was (66.7 ± 24.5) points and that of the radiotherapy and chemotherapy group was (76.7 ± 13.0) points, the difference was statistically significant (t = 5.039, P <0.05). Side effects of chemotherapy are mainly nausea and vomiting and other digestive reactions, occasionally headache, rash and cytopenia, are Ⅰ ~ Ⅱ grade, after symptomatic treatment significantly reduced or disappeared symptoms, no grade Ⅲ and above toxicity. Followed up for 3 years, 18 died and 3 survived. The median survival time of radiotherapy alone group and radiotherapy and chemotherapy group were 19 months and 26 months, respectively, the difference was statistically significant (P = 0.009). The 1-year and 2-year survival rates of radiotherapy alone group were 77.8% and 11.1%, respectively. The 1-year and 2-year survival rates of radiotherapy and chemotherapy group were 83.3% and 50.0% respectively. Conclusion Three-dimensional conformal radiotherapy combined with temozolomide chemotherapy can significantly improve the quality of life of patients with diffuse brain stem glioma, prolong the survival period, and has good application prospects.