老年胶质母细胞瘤患者规范化治疗疗效及安全性分析
发布时间：2018-05-06 01:45
本文选题：胶质母细胞瘤 + 老年 ； 参考：《大连医科大学》2014年硕士论文
【摘要】：目的：本文通过对胶质母细胞瘤规范化治疗方案在老年人群中的疗效及安全性进行分析，从而论证该方案在老年人群中的适用性，并为老年GBM患者的临床研究提供参考及资料。 方法：选择2009年1月至2013年12月于大连医科大学附属第一院收治行神经外科显微手术治疗并经术后病理证实为胶质母细胞瘤的36例病人，按照年龄分布将其分老年组（年龄≥65岁）患者例数15例，非老年组（年龄＜65岁）患者21例。于手术后2周开始进行直线加速器放疗，放射总剂量为60Gy，每次2Gy，一日一次，每周进行5天，总疗程6周，并于放疗的同时给予患者口服替莫唑胺胶囊，剂量75mg/m2/d。放疗结束后4周继续给予患者TMZ口服，剂量为150mg/m2，连续用药5天，以28天为一个疗程。于第二疗程将剂量增加至200mg/m2。共6个疗程。术后对患者进行随访，术后72小时之内复查头部MRI，放疗结束后1个月-3个月复查头部MRI(平扫+增强）或头部CT（平扫+增强），明确治疗效果，评价标准依据WHO实体瘤疗效评价标准。并密切监测患者的血液学及生化学指标等，，分析比较患者中位生存时间及无进展生存时间。不良反应评定标准依据国际肿瘤组织毒性分级标准3.0版本。用SPSS19.0统计软件进行资料处理，应用t检验、X2检验、对数秩和检验（Log-Rank）、Kaplan-Meier生存分析法等，P㩳0.05为有统计学意义。 结果： 1.老年组有效率为27.3%，非老年组有效率为52.4%。两组差异经统计学分析后P＜0.05，具有统计学意义。 2.老年组患者中位生存时间为15.2个月，非老年组患者中位生存时间为21.6个月。两组差异经统计学分析后P＜0.05，具有统计学意义。老年组患者无进展生存时间为8.4个月，非老年组患者无进展生存期为12.7个月，两组差异经统计学分析后P＞0.05，无统计学意义。 3.不良反应：同步放化疗阶段，白细胞减少症、中性粒细胞减少症老年组发生率高于非老年组，但经统计学分析后均无统计学意义。淋巴细胞减少症发生率分别为老年组27%，非老年组52%,两组差异经统计学分析后P＜0.05，具有统计学意义。血小板减少症只在老年组出现，发生率13%，两组差异经统计学分析后P＜0.05，具有统计学意义。严重毒性反应（CTC3级以上）的发生率，老年组33%，非老年组52%，P＞0.05，无统计学意义。CTC4级不良反应发生率，老年组27%，非老年组5%，P＜0.05，两组差异具有统计学意义。辅助化疗阶段，中性粒细胞减少症、血小板减少症、CTC4级毒性反应发生率老年组高于非老年组；白细胞减少症、淋巴细胞减少症、严重毒性反应（CTC3级以上）的发生率，非老年组患者高于老年组患者，但对这些数据进行检验P值均大于0.05，故无统计学意义。 4.经多因素COX回归分析后发现年龄、性别、术前KPS评分、肿瘤切除范围4项因素在老年GBM患者预后分析中均无统计学意义。 结论： 1.现阶段规范化治疗方案对于老年GBM患者来说并不是最佳治疗方案，许多方面值得改进，尤其在同步放化疗阶段更为明显； 2.经过规范化治疗后，老年组患者在疗效、中位生存时间差于非老年组患者； 3.在同步放化疗阶段，3级以上的毒性反应发生率两组患者无明显差异，而最为严重的4级毒性反应，老年组患者明显高于非老年组患者； 4.在辅助化疗阶段，不良反应发生率在老年组患者及非老年组患者无明显差异； 5.对于老年GBM患者，性别、年龄、KPS评分、手术切除程度均不是判断患者预后的有效指标。
[Abstract]:Objective: to analyze the efficacy and safety of the standardized treatment of glioblastoma in the elderly population, and to demonstrate the applicability of the scheme in the elderly and to provide reference and data for the clinical study of the elderly GBM patients.
Methods: from January 2009 to December 2013, 36 patients with glioblastoma confirmed by microsurgery in the First Affiliated Hospital of Dalian Medical University were selected and confirmed by pathology after operation. According to the age distribution, there were 15 cases in the elderly group (age 65 years old) and 21 cases of non aged group (age 65 years old). 2 At the beginning of the week, a linear accelerator radiotherapy was carried out with a total dose of 60Gy, 2Gy each time, once a day, 5 days a week, a total course of 6 weeks. At the same time, the patients were given oral Temozolomide Capsules at the same time as radiotherapy. After the dose of 75mg/m2/d. radiotherapy, the patient was given TMZ oral administration, the dose was 150mg/m2, the continuous medication was 5 days, and 28 days as a course of treatment. The second course of treatment increased the dose to a total of 6 courses of 200mg/m2.. After the operation, the patients were followed up and the head MRI was rechecked within 72 hours after the operation. After the radiotherapy, the head MRI (plain scan + enhancement) or the head CT (plain scan + enhancement) was rechecked for 1 months after the end of the radiotherapy, and the therapeutic effect was determined. The evaluation criteria were based on the evaluation criteria of the curative effect of WHO solid tumor and closely monitored the blood of the patients. The median survival time and the non progressive survival time of the patients were analyzed and compared. The standard of assessment of adverse reactions was based on the version 3 of the international tumor organization toxicity classification standard. The SPSS19.0 statistical software was used for data processing, t test, X2 test, logarithmic rank and test (Log-Rank), Kaplan-Meier survival analysis, and P? 0.05 There is a statistical significance.
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