本文選題：膠質(zhì)母細胞瘤 + 老年��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：本文通過對膠質(zhì)母細胞瘤規(guī)范化治療方案在老年人群中的療效及安全性進行分析，從而論證該方案在老年人群中的適用性，并為老年GBM患者的臨床研究提供參考及資料。 方法：選擇2009年1月至2013年12月于大連醫(yī)科大學(xué)附屬第一院收治行神經(jīng)外科顯微手術(shù)治療并經(jīng)術(shù)后病理證實為膠質(zhì)母細胞瘤的36例病人，按照年齡分布將其分老年組（年齡≥65歲）患者例數(shù)15例，非老年組（年齡＜65歲）患者21例。于手術(shù)后2周開始進行直線加速器放療，放射總劑量為60Gy，每次2Gy，一日一次，每周進行5天，總療程6周，并于放療的同時給予患者口服替莫唑胺膠囊，劑量75mg/m2/d。放療結(jié)束后4周繼續(xù)給予患者TMZ口服，劑量為150mg/m2，連續(xù)用藥5天，以28天為一個療程。于第二療程將劑量增加至200mg/m2。共6個療程。術(shù)后對患者進行隨訪，術(shù)后72小時之內(nèi)復(fù)查頭部MRI，放療結(jié)束后1個月-3個月復(fù)查頭部MRI(平掃+增強）或頭部CT（平掃+增強），明確治療效果，評價標(biāo)準依據(jù)WHO實體瘤療效評價標(biāo)準。并密切監(jiān)測患者的血液學(xué)及生化學(xué)指標(biāo)等，，分析比較患者中位生存時間及無進展生存時間。不良反應(yīng)評定標(biāo)準依據(jù)國際腫瘤組織毒性分級標(biāo)準3.0版本。用SPSS19.0統(tǒng)計軟件進行資料處理，應(yīng)用t檢驗、X2檢驗、對數(shù)秩和檢驗（Log-Rank）、Kaplan-Meier生存分析法等，P㩳0.05為有統(tǒng)計學(xué)意義。 結(jié)果： 1.老年組有效率為27.3%，非老年組有效率為52.4%。兩組差異經(jīng)統(tǒng)計學(xué)分析后P＜0.05，具有統(tǒng)計學(xué)意義。 2.老年組患者中位生存時間為15.2個月，非老年組患者中位生存時間為21.6個月。兩組差異經(jīng)統(tǒng)計學(xué)分析后P＜0.05，具有統(tǒng)計學(xué)意義。老年組患者無進展生存時間為8.4個月，非老年組患者無進展生存期為12.7個月，兩組差異經(jīng)統(tǒng)計學(xué)分析后P＞0.05，無統(tǒng)計學(xué)意義。 3.不良反應(yīng)：同步放化療階段，白細胞減少癥、中性粒細胞減少癥老年組發(fā)生率高于非老年組，但經(jīng)統(tǒng)計學(xué)分析后均無統(tǒng)計學(xué)意義。淋巴細胞減少癥發(fā)生率分別為老年組27%，非老年組52%,兩組差異經(jīng)統(tǒng)計學(xué)分析后P＜0.05，具有統(tǒng)計學(xué)意義。血小板減少癥只在老年組出現(xiàn)，發(fā)生率13%，兩組差異經(jīng)統(tǒng)計學(xué)分析后P＜0.05，具有統(tǒng)計學(xué)意義。嚴重毒性反應(yīng)（CTC3級以上）的發(fā)生率，老年組33%，非老年組52%，P＞0.05，無統(tǒng)計學(xué)意義。CTC4級不良反應(yīng)發(fā)生率，老年組27%，非老年組5%，P＜0.05，兩組差異具有統(tǒng)計學(xué)意義。輔助化療階段，中性粒細胞減少癥、血小板減少癥、CTC4級毒性反應(yīng)發(fā)生率老年組高于非老年組；白細胞減少癥、淋巴細胞減少癥、嚴重毒性反應(yīng)（CTC3級以上）的發(fā)生率，非老年組患者高于老年組患者，但對這些數(shù)據(jù)進行檢驗P值均大于0.05，故無統(tǒng)計學(xué)意義。 4.經(jīng)多因素COX回歸分析后發(fā)現(xiàn)年齡、性別、術(shù)前KPS評分、腫瘤切除范圍4項因素在老年GBM患者預(yù)后分析中均無統(tǒng)計學(xué)意義。 結(jié)論： 1.現(xiàn)階段規(guī)范化治療方案對于老年GBM患者來說并不是最佳治療方案，許多方面值得改進，尤其在同步放化療階段更為明顯； 2.經(jīng)過規(guī)范化治療后，老年組患者在療效、中位生存時間差于非老年組患者； 3.在同步放化療階段，3級以上的毒性反應(yīng)發(fā)生率兩組患者無明顯差異，而最為嚴重的4級毒性反應(yīng)，老年組患者明顯高于非老年組患者； 4.在輔助化療階段，不良反應(yīng)發(fā)生率在老年組患者及非老年組患者無明顯差異； 5.對于老年GBM患者，性別、年齡、KPS評分、手術(shù)切除程度均不是判斷患者預(yù)后的有效指標(biāo)。
[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.
Result錛

本文編號：1850255