(重庆市石柱土家族自治县人民医院 重庆 石柱 409100)
【摘要】目的:对恶性胶质瘤补救性化疗的临床方案和疗效进行探讨。方法:选取复发性恶性胶质瘤的补救性化疗病例80例,均进行手术治疗,术后的病理证实是胶质2~4级。随机分为实验组和对照组,各40例。实验组为ACNU联合CDDP72小时持续灌注化疗组,对照组为替莫唑胺化疗组。结果:实验组中PR17例,SD10例,PD13例,缓解率42.5%。对照组PR3例,SD17例,PD20例,缓解率到7.50%。实验组的近期缓解率高于对照组,差异显著(P<0.01)。从第一次化疗开始算起,实验组的生存期9.1±1.0个月,生存率28.0%。对照组的生存期是8.2±3.6个月,为18.5%。差异不显著(P>0.05)。结论:在术前应用ACNU联合CDDP72小时持续灌注化疗法,能显著提高手术全切率,减少手术后的复发率。
【关键词】恶性胶质瘤;补救性化疗
【中图分类号】R739.41 【文献标识码】A 【文章编号】2095-1752(2017)36-0032-02
Clinical study of salvage chemotherapy for malignant glioma
Zhong Shihong,Li Wenke(Correspondent).
Chongqing Shizhu Tujia Autonomous County People's Hospital Chongqing Shizhu post code 409100,China
【Abstract】Objective To investigate the clinical regimen and curative effect of salvage chemotherapy for malignant glioma, and to take effective treatment measures. Methods 80 cases of recurrent malignant glioma treated in our hospital from December 2015 to March 2017 were selected. These patients underwent surgical treatment. The postoperative pathology confirmed that the colloid was 2, 4 and one. The patients were divided into experimental group and control group by random grouping method, 40 cases each. The experimental group was ACNU combined with CDDP72 hour continuous infusion chemotherapy group, and the control group was temozolomide chemotherapy group.To evaluate the short-term and long-term survival rates of two types of chemotherapy for recurrent malignant gliomas.Results In the experimental group, there were 17 cases of PR, 10 cases of SD, 13 cases of PD, and the rate of remission reached 42.5%. In the control group, there were 3 cases of PR, 17 cases of SD, 20 cases of PD, and the remission rate reached 7.50%. The short-term remission rate of the experimental group was significantly higher than that of the control group, the difference was statistically significant (P<0.01). From the beginning of the first chemotherapy, the average survival time of the experimental group was 9.1±1 months, and the 1-year survival rate was 28%. From the start of the first chemotherapy, the mean survival time of the control group was 8.2±3.6 months, and the 1-year survival rate was 18.5%. There was no significant difference between the two groups, and there was no statistical significance (P>0.05). Conclusion Preoperative ACNU combined with CDDP72 hour continuous perfusion therapy can significantly improve the total resection rate, reduce the postoperative recurrence rate, and the effect is good. It is worth popularizing.
【Key words】Malignant glioma; Salvage chemotherapy
1.资料与方法
1.1 一般资料
选取我院在2015年12月至2017年3月收治的复发性恶性胶质瘤的补救性化疗病例80例,均进行手术治疗,病理证实是胶质2~4级。其中,实验组男23例,女17例,年龄24~59岁。在术后复发前有24例患者接受放射治疗,11例接受其他化疗方案,5例未进行化疗。肿瘤平均复发时间是自手术后的7.3±3.8个月。20例在术后一年内复发,在化疗前有28例KPS评分≥70分,12例≥50分、<70分。对照组男性28例,女性12例,年龄均在23~57岁之间,平均为(42.5±2.8)岁。在术后复发前有29例患者接受放射治疗,8例接受其他化疗方案,4例未进行化疗。肿瘤平均复发时间是自手术后的7.9±2.9个月。21例在术后一年内复发,在化疗前有16例KPS评分≥70分,24例≥50分、<70分。
1.2 研究方法
实验组在化疗前1天进行补液水化、5%碳酸氧钠碱化、利尿等预处理。化疗使用CDDP(30mg-1·m-2·d-1)和ACNU(30mg-1·m-1·d-1)持续2天静脉灌注。在化疗期间患者需开放三路静脉,每天适当量给予止吐药物、利尿药物以及5%碳酸氧钠碱化处理,每日补液量至少2500ml,化疗后继续水化、碱化两天。一个周期为4周。
对照组起始剂量是200mg-1·m-2·d-1,空腹连续服用5天,在用药之前需要口服止吐药物。7天之后绝对中性白细胞计数(ANC)≥1.5×1.09|L、血小板计数≥100×1.09|L的患者继续200mg-1·m-2·d-1。
1.3 评价指标
化疗后每周进行肝肾功能、血常规的复查,两周期化疗后进行头部平扫+强化MRI复查,跟化疗前的MRI相比,肿瘤都消失的为完全缓解(CR).肿瘤缩小大于50%以上为部分缓解(PR),肿瘤缩小没有达到50%或增大没有大于25%的为病情稳定(SD),肿瘤增大超过25%或有新发病灶为病情进展(PD)。
2.结果
2.1 近期疗效
实验组24例接受化疗的患者中有10例进行了1周期化疗,14例进行两周期化疗,对照组29例中所有患者进行4~6周期的化疗。化疗后评价为PD:患者放弃主动终止化疗。实验组中PR有17例,SD有10例,PD有13例,缓解率到达42.5%。对照组中PR有3例,SD有17例,PD有20例,缓解率到达7.50%。差异显著(P<0.01)。
2.2 两组患者生存率对比
从第一次化疗开始算起,实验组的平均生存期是9.1±1.0个月,一年生存率是28.0%。从第一次化疗开始算起,对照组的平均生存期是8.2±3.6个月,一年生存率是18.5%。两组比较差异不显著,不具统计学意义(P>0.05)。见表。
3.讨论
临床研究发现,使用ACNU联合CDDP72小时持续灌注化疗肿瘤缩小明显,见效快,还能够降低术后复发率,值得推广应用。
【参考文献】
[1]李鹏.恶性胶质瘤补救性化疗的临床与实验研究[D].天津医科大学,2014.
[2]邱俊,易勇.脑恶性胶质瘤术后放化疗肿瘤复发再手术治疗的临床研究[J].环球中医药,2015(s2).
[3]步星耀,郭晓鹤,丁玉超,等.脑恶性胶质瘤术后放化疗肿瘤复发再手术治疗的临床研究[J].中华临床医师杂志:电子版,2012,06(5):36-39.
[4]刘海龙,李岳虹,葛红.恶性胶质瘤术后放化疗临床研究[J].医药论坛杂志,2004,25(8):10-12.
论文作者:钟世洪,李文科
论文发表刊物:《医药前沿》2017年12月第36期
论文发表时间:2018/3/20
标签:实验组论文; 术后论文; 肿瘤论文; 对照组论文; 患者论文; 生存率论文; 个月论文; 《医药前沿》2017年12月第36期论文;