替莫唑胺同期全脑放疗治疗脑转移瘤的疗效观察

发布时间：2018-05-15 01:11

本文选题：替莫唑胺 + 同期放化疗　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:通过观察口服替莫唑胺同步全脑放疗后不序贯化疗治疗脑转移瘤的近期疗效、毒副反应及生存率,用统计方法分析脑转移瘤同步放化疗后不序贯化学药物治疗的毒副反应,治疗效果及1年生存率,总结适宜脑转移瘤的个性化方案进行治疗。方法:收集2011年1月-2013年12月就诊于我院肿瘤放疗科的转移性脑肿瘤患者,其中符合纳入和排除标准的患者有40例。对病历资料进行详细的统计分析,根据治疗的方法不同进行分组,可分为替莫唑胺同期放化疗组(A组)和放疗组(B组)。AB两组患者均接受直线加速器6m V-X线全脑两侧对穿野等中心放射治疗,DT30Gy/10次,5次/周。A组患者行全脑放射治疗同时给予替莫唑胺每日75mg/m2口服治疗,连续服用14d,完成放射治疗时,停止给药。结果:替莫唑胺同期全脑放疗组16例,其中男女患者比例12:4,年龄38-70岁(54.94±2.39);单纯放疗24例,其中男女患者比例15:9,年龄35-74岁(53.29±2.22)。本资料中,非小细胞肺癌为最主要的原发病来源(19例),其次是小细胞肺癌、乳腺肿瘤、胃肠道癌症等;两组患者脑内转移灶多为2-3个。以上两组间资料经卡方检验(p值0.05)或t检验(p0.05),均无统计学意义。替莫唑胺同期全脑放疗与单纯全脑放疗患者的白细胞、血红蛋白、血小板降低的发生率分别为81.25%和45.83%、31.25%和20.83%、18.75%和12.5%,其中具有统计学意义的只有白细胞计数的下降;两组患者的恶心、呕吐发生率分别为87.5%和79.17%,p0.05无统计学差异;替莫唑胺同期全脑放疗的头痛发生率为75%,单纯全脑放疗患者的头痛发生率为83.33%,p0.05无统计学差异。替莫唑胺同期全脑放疗组治疗有效率为87.5%,其中完全缓解6例;单纯全脑放射性治疗组治疗有效率为54.17%,其中有3例完全缓解,统计值P0.05提示两组间差别有意义。AB两组患者的生存率分别为56.25%和29.17%,p0.05提示有差异。结论:转移性脑瘤患者使用替莫唑胺联合全脑放射治疗(A组)的毒副反应与单纯放射治疗(B组)相比,只有在白细胞计数中两组间差异,p0.05提示有意义,但患者可耐受。A组的近期疗效优于B组,同时A组与B组相比显著提高了患者的1年生存率。
[Abstract]:Objective: to observe the short-term efficacy, toxicity and survival rate of non-sequential chemotherapy for brain metastases after simultaneous whole-brain radiotherapy with temozolidomide. The side effects, therapeutic effects and 1-year survival rate of nonsequential chemotherapeutic therapy after simultaneous radiotherapy and chemotherapy for brain metastases were analyzed by statistical method. Methods: from January 2011 to December 2013, 40 patients with metastatic brain tumors who met the criteria of inclusion and exclusion were collected. Detailed statistical analysis of medical records, grouping according to different treatment methods, The patients in group A and group B were treated with linear accelerator 6m V-X radiography on both sides of the brain with isocentric radiation therapy of DT30Gy / 10 times / week. Temozolidomide was given daily oral treatment of 75mg/m2, Continue to take 14 days, complete radiotherapy, stop the drug. Results: there were 16 patients in temozolidomide group, including 12: 4 male / female patients aged 38-70 years (54.94 卤2.39) and 24 patients with radiotherapy alone (15: 9 male / female, aged 35-74 years, 53.29 卤2.22). In this study, non-small cell lung cancer (NSCLC) was the main primary source of 19 cases, followed by small cell lung cancer (SCLC), breast cancer, gastrointestinal cancer, etc. There was no statistical significance between the two groups by chi-square test (P = 0.05) or t-test (P = 0.05). The incidence of leukocyte, hemoglobin and thrombocytopenia were 81.25% and 45.83% and 20.83%, respectively. There was no significant difference in the incidence of vomiting between 87.5% and 79.17% (P 0.05), but there was no significant difference in the incidence of headache between two groups (75% and 83.33%, respectively). The effective rate of temozolidomide group was 87.5%, of which 6 cases were completely relieved, while that of pure whole brain radiation group was 54.17 cases, of which 3 cases were completely relieved. The survival rate of the two groups was 56.25% and 29.17% respectively. Conclusion: in patients with metastatic brain tumor treated with temozolidomide combined with whole-brain radiotherapy (group A), only the difference between the two groups in leukocyte count indicates that there is significant difference between the two groups. But the short-term curative effect of group A was better than that of group B, and the 1-year survival rate of group A was significantly higher than that of group B.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R739.41

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