替莫唑胺同步放疗治疗脑转移瘤的临床研究

发布时间：2018-05-06 14:13

本文选题：全脑放疗 + 替莫唑胺　；参考：《延安大学》2017年硕士论文

【摘要】：目的:本研究通过评价替莫唑胺化疗同步全脑放疗治疗脑转移瘤的临床近期疗效和毒副反应,观察安替莫唑胺全性及有效性,为脑转移瘤患者提供更加有效地治疗方案。方法:2014年01月~2016年12月就诊于延安大学附属医院肿瘤科,病理证实有原发灶,并且经脑部CT和/或MRI确诊的46例脑转移瘤病人,根据脑转移灶的治疗方式不同分为按照随机数字表将符合纳入标准的受试者同步放化疗组和单纯放疗组。单纯放疗组中的病人仅接受全脑放疗,根据患者转移数目情况给予局部加量10~20Gy。同步放化疗组的病人接受全脑放疗联合口服替莫唑胺化疗。全脑放疗方案如下:采用6MV X线行全脑放疗,DT 40Gy,2.0Gy/f,放疗4周结束,必要时给予局部加量10~20Gy/5~10次至50~60Gy。替莫唑胺化疗方案如下:患者口服替莫唑胺75 mg/(m2·d),一直服用至放射治疗结束。放疗结束1个月后两组病人分别行头颅CT或MRI,根据WHO推荐的实体瘤疗效评价标准对治疗的近期疗效进行评价,口服替莫唑胺或同步放化疗过程中详细记录不良事件(Adverse Event,AE),AE的评价使用美国国立癌症研究所不良事件常用术语评定标准3.0版评价。研究结果采用SPSS 22.0软件包进行统计分析,观察其近期有效率及不良反应是否有统计学意义,评价替莫唑胺及同步全脑放疗的近期疗效和安全性,以及是否能为脑转移瘤患者提供最佳的治疗方案,提高病人生活质量。结果:经比较,两组患者的年龄、性别、KPS评分、原发肿瘤部位、病理类型、以及其他器官的转移情况差异均无统计学意义(P0.05);两组患者脑转移瘤的数目、发现情况及脑转移部位差异均无统计意义(P0.05),观察两组有效率及控制率得出结果:(1)同步放化疗组患者治疗有效率较单纯放疗组的患者有升高趋势,但是差异无计学意义(P0.05);同步放化疗组患者疾病控制率较单纯放疗组中的病人显著升高(P0.05);(2)脑转移瘤病人的放化疗后的毒副反应的组织器官分类表现为血象异常、胃肠功能紊乱、皮肤、肝肾功能异常等,血小板和白细胞计数降低、脱发、恶心呕以及头晕头痛是最常见的不良事件,但是两组各项不良事件的发生频率和严重程度差异均无统计学意义(P0.05)。结论:(1)全脑放疗同步替莫唑胺化疗治疗脑转移瘤较单纯全脑放疗可显著改善脑转移瘤的近期疗效;(2)全脑放疗同步替莫唑胺化疗和单纯全脑放疗治疗脑转移瘤具有相似的安全性,毒副反应可以耐受。
[Abstract]:Objective: to evaluate the efficacy and toxicity of temozolidomide in the treatment of brain metastases, and to provide a more effective treatment for patients with brain metastases. Methods: from January 2014 to December 2016, 46 patients with brain metastases confirmed by pathology and confirmed by CT and / or MRI were admitted to the Department of Oncology, affiliated Hospital of Yan'an University. According to the different treatment methods of brain metastases, they were divided into two groups: concurrent radiotherapy and chemotherapy group and radiotherapy group. Patients in the radiotherapy alone group received whole-brain radiotherapy and were given a local dose of 10 ~ 20 Gy according to the number of metastases. Patients in the concurrent radiotherapy and chemotherapy group received whole-brain radiotherapy combined with oral temozolidomide chemotherapy. The plan of whole brain radiotherapy was as follows: whole brain radiation was performed with 6MV X ray and DT40 Gyr 2.0 Gy / f. after 4 weeks of radiotherapy, local dose of 10~20Gy/5~10 was given to 50 ~ 60Gy. if necessary. The chemotherapy regimen of temozolidomide was as follows: the patient was given temozolidomide 75 mg/(m2 DX until the end of radiotherapy. One month after the end of radiotherapy, two groups of patients were treated with CT or MRI respectively. According to the criteria recommended by WHO for evaluating the curative effect of solid tumor, the short-term curative effect was evaluated. Evaluation of adverse events in oral temozolidomide or concurrent radiotherapy and chemotherapy the evaluation of Adverse Eventin AEN AE was evaluated using the commonly used term for adverse events in the National Cancer Institute version 3.0. The results were statistically analyzed by SPSS 22.0 software package. The short-term efficacy and safety of temozolidomide and simultaneous whole brain radiotherapy were evaluated. And whether to provide the best treatment for patients with brain metastases, improve the quality of life of patients. Results: there was no significant difference in age, sex and KPS score, primary tumor location, pathological type and metastasis of other organs between the two groups (P 0.05), and the number of brain metastases in the two groups. The results showed that there was no statistical significance in the difference of brain metastases between the two groups. The effective rate and control rate of the two groups were observed. The results showed that the effective rate of the simultaneous radiotherapy and chemotherapy group was higher than that of the patients in the radiotherapy alone group. The disease control rate of patients with concurrent radiotherapy and chemotherapy was significantly higher than that of patients in radiotherapy group. (2) the tissue and organ classification of side effects after radiotherapy and chemotherapy in patients with brain metastases were abnormal in blood and gastrointestinal dysfunction. Abnormal skin, liver and kidney function, decreased platelet and white blood cell count, alopecia, nausea and headache were the most common adverse events, but there was no significant difference in the frequency and severity of each kind of adverse events between the two groups (P 0.05). Conclusion (1) combined global brain radiotherapy with temozolidomide chemotherapy can significantly improve the short-term efficacy of brain metastases compared with global radiotherapy alone. (2) simultaneous global brain radiotherapy with temozolidomide chemotherapy and whole-brain radiotherapy alone has similar safety in the treatment of brain metastases. Toxicity can be tolerated.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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