CAJ | 학술논문

目的：探讨三维适型放射治疗结合替莫唑胺治疗弥漫性脑干胶质瘤的临床疗效。方法选择2006年1月-2010年1月在我院住院治疗的弥漫性脑干胶质瘤患者21例，根据治疗方法分为单纯放疗组9例，放化疗同步组12例。单纯放疗组采用三维适型放射治疗，放化疗同步组采用三维适型放射治疗结合替莫唑胺化疗。观察两组生活质量评分（ KPS评分）、毒副作用，随访患者生存时间（治疗开始至死亡）。结果治疗前，单纯放疗组 KPS 评分为（68.3±5.0）分，放化疗同步组为（69.2±6.3）分，差异无统计学意义（ t=0.053，P>0.05）。治疗6个月后单纯放疗组KPS评分为（66.7±24.5）分，放化疗同步组为（76.7±13.0）分，差异有统计学意义（t =5.039，P <0.05）。化疗毒副作用主要是恶心呕吐等消化系统反应，偶见头痛、皮疹和血细胞减少，均属Ⅰ~Ⅱ级，经对症治疗后症状明显减轻或消失，无Ⅲ级及以上毒副作用。随访3年，死亡18例，存活3例。单纯放疗组和放化疗同步组中位生存时间分别为19个月和26个月，差异有统计学意义（ P=0.009）。单纯放疗组1年和2年生存率分别为77.8%和11.1%，放化疗同步组1年和2年生存率分别为83.3%和50.0%。结论三维适型放射治疗结合替莫唑胺化疗可明显改善弥漫性脑干胶质瘤患者生活质量，延长生存期，具有良好的应用前景。
목적：탐토삼유괄형방사치료결합체막서알치료미만성뇌간효질류적림상료효。방법선택2006년1월-2010년1월재아원주원치료적미만성뇌간효질류환자21례，근거치료방법분위단순방료조9례，방화료동보조12례。단순방료조채용삼유괄형방사치료，방화료동보조채용삼유괄형방사치료결합체막서알화료。관찰량조생활질량평분（ KPS평분）、독부작용，수방환자생존시간（치료개시지사망）。결과치료전，단순방료조 KPS 평분위（68.3±5.0）분，방화료동보조위（69.2±6.3）분，차이무통계학의의（ t=0.053，P>0.05）。치료6개월후단순방료조KPS평분위（66.7±24.5）분，방화료동보조위（76.7±13.0）분，차이유통계학의의（t =5.039，P <0.05）。화료독부작용주요시악심구토등소화계통반응，우견두통、피진화혈세포감소，균속Ⅰ~Ⅱ급，경대증치료후증상명현감경혹소실，무Ⅲ급급이상독부작용。수방3년，사망18례，존활3례。단순방료조화방화료동보조중위생존시간분별위19개월화26개월，차이유통계학의의（ P=0.009）。단순방료조1년화2년생존솔분별위77.8%화11.1%，방화료동보조1년화2년생존솔분별위83.3%화50.0%。결론삼유괄형방사치료결합체막서알화료가명현개선미만성뇌간효질류환자생활질량，연장생존기，구유량호적응용전경。
Objective Toinvestigatetheefficacyofthree-dimensionalconformalradiotherapycombinedwithtemozo-lomideinthetreatmentofdiffusebrainstemglioma.Methods Theclinicaldataof21brainstemgliomacasesinourhospitalfrom January 2006 to January 2010 were retrospectively analyzed. They were randomly divided into three-dimensional conformal radio-therapy group(9 cases)and radiotherapy combined with temozolomide chemotherapy group(12 cases). KPS scores were used to evaluate the quality of life. Survival time and adverse effect( the start of treatment until death)were determined through follow-up.Results Beforetreatment,therewasnosignificantdifferenceinKPSscoresbetweenradiotherapygroupandchemotherapy and radiotherapy group〔(68. 3 ±5. 0)vs. (69. 2±6. 3),t=0. 053,P>0. 05〕. After six months treatment,the KPS of concurrent chemotherapy and radiotherapy group was significantly higher than the KPS of radiotherapy group〔(76. 7±13. 0)vs. (66. 7 ±24. 5),t=5. 039,P<0. 05〕. The adverse effects of chemotherapy were mainly nausea and vomit,as well as occa-sional headache,rash and hypocytosis,ⅠtoⅡlevel. The adverse effects were alleviated after treatment. No adverse effect higher than level Ⅲ was found. During the three years follow up,18 cases died and 3 cases survived. The median survival time of the two groups was 19 months and 26 months respectively,showing statistically significant difference(P=0. 009). The one-year and two-year survival rate of radiotherapy group was 77. 8% and 11. 1% respectively,while the number for the concurrent chemo-therapyandradiotherapygroupwas83.3%and50.0%.℅onclusion Three-dimensionalconformalradiotherapycombinedwith temozolomide chemotherapy can significantly improve the life quality of brainstem low-grade glioma( diffuse)patients and pro-long their survival,with a good application prospect.