摘要
目的：采用前瞻性方法研究放疗联合替莫唑胺或尼莫司汀与单纯放疗治疗弥漫内生型脑干胶质瘤（diffuse intrinsic brain stem glioma,DBSG）的疗效和预后因素。方法：2005年3月起采用前瞻性方法治疗DBSG患者。将患者分成3个治疗组：单纯放疗组、放疗联合尼莫司汀组和放疗联合替莫唑胺组。放疗为常规分割放疗,放射总剂量为54Gy,2Gy/次,共27次。记录治疗反应,计算总体生存率和无局部进展生存率,应用COX回归模型进行多因素预后分析。结果：至2009年4月,共入组54例患者,其中单纯放疗组13例、放疗联合尼莫司汀组14例、放疗联合替莫唑胺组27例。本组患者的急性治疗反应多为Ⅰ~Ⅱ级,无Ⅳ级以上反应。1、2和3年总生存率分别为60.1%、35.7%和28.4%;多因素分析显示治疗前症状持续时间（P〈0.001）和Karnofsky评分（P=0.010）是独立的预后因素。1、2和3年无局部进展生存率分别为41.6%、29.5%和22.1%;多因素分析显示,治疗前症状持续时间（P=0.013）、Karnofsky评分（P=0.038）和年龄（P=0.039）是独立的预后因素。3个治疗组的3年总生存率和无局部进展生存率差异无统计学意义。结论：本研究结果显示,DBSG预后差,放疗联合替莫唑胺或尼莫司汀化疗的疗效与单纯放疗无明显差异。症状持续时间、Karnofsky评分和年龄是重要的预后因素。今后将尝试扩大样本量开展替莫唑胺同期放化疗与放疗联合新的细胞毒药物治疗DBSG的研究。
Objective：To study the outcome and prognostic factors of conventional radiotherapy combined with temozolomide/nimustine and radiation therapy alone in the treatment of diffuse intrinsic brain stem glioma（DBSG）prospectively.Methods：Consecutive patients with DBSG were enrolled in this study,and they were divided into three groups：radiotherapy alone,radiotherapy combined with nimustine,and radiotherapy combined with temozolomide.Conventional radiotherapy was used,and the total dose was 54 Gy in 27 fractions.The treatment reactions were recorded,and the overall survival rate and local progression-free survival rate were calculated.The prognostic factors were analyzed by multivariate COX regression model.Results：From March 2005 to April 2009,a total of 54 consecutive patients with DBSG were enrolled in this study.Thirteen patients received radiotherapy alone,14 patients received radiotherapy combined with nimustine,and 27 patinets received radiotherapy combined with temozolomide.Most of the acute treatment toxicities were grade Ⅰ-Ⅱ,and grade Ⅳ toxicity was not found.The 1-,2-and 3-year overall survival rates were 60.1%,35.7% and 28.4%,respectively.Multivariate analysis revealed that the duration of symptoms before treatment（P〈0.001）and Karnofsky score（P=0.010）were independent prognostic factors.The 1-,2-and 3-year local progression-free survival rates were 41.6%,29.5% and 22.1%,respectively.Multivariate analysis revealed that duration of symptoms before treatment（P=0.013）,Karnofsky score（P=0.038）and age（P=0.039）were independent prognostic factors.The difference of survival among three groups was not significant.Conclusion：No survival benefit was seen in the arm of conventional radiotherapy combined with temozolomide or nimustine compared with radiation the-rapy alone.Duration of symptoms before treatment,Karnofsky score and age were important prognostic factors.A large cohort study of radiotherapy combined with concomitant temozolomide and the trials of radiotherapy combined w
出处
《肿瘤》
CAS
CSCD
北大核心
2010年第12期1042-1047,共6页
Tumor
关键词
脑干肿瘤
放射疗法
药物疗法
预后
Brain stem neoplasms； Radiotherapy； Drug therapy； Prognosis
