本文選題：全腦放療 + 替莫唑胺　； 參考：《延安大學》2017年碩士論文

【摘要】：目的:本研究通過評價替莫唑胺化療同步全腦放療治療腦轉(zhuǎn)移瘤的臨床近期療效和毒副反應,觀察安替莫唑胺全性及有效性,為腦轉(zhuǎn)移瘤患者提供更加有效地治療方案。方法:2014年01月~2016年12月就診于延安大學附屬醫(yī)院腫瘤科,病理證實有原發(fā)灶,并且經(jīng)腦部CT和/或MRI確診的46例腦轉(zhuǎn)移瘤病人,根據(jù)腦轉(zhuǎn)移灶的治療方式不同分為按照隨機數(shù)字表將符合納入標準的受試者同步放化療組和單純放療組。單純放療組中的病人僅接受全腦放療,根據(jù)患者轉(zhuǎn)移數(shù)目情況給予局部加量10~20Gy。同步放化療組的病人接受全腦放療聯(lián)合口服替莫唑胺化療。全腦放療方案如下:采用6MV X線行全腦放療,DT 40Gy,2.0Gy/f,放療4周結(jié)束,必要時給予局部加量10~20Gy/5~10次至50~60Gy。替莫唑胺化療方案如下:患者口服替莫唑胺75 mg/(m2·d),一直服用至放射治療結(jié)束。放療結(jié)束1個月后兩組病人分別行頭顱CT或MRI,根據(jù)WHO推薦的實體瘤療效評價標準對治療的近期療效進行評價,口服替莫唑胺或同步放化療過程中詳細記錄不良事件(Adverse Event,AE),AE的評價使用美國國立癌癥研究所不良事件常用術(shù)語評定標準3.0版評價。研究結(jié)果采用SPSS 22.0軟件包進行統(tǒng)計分析,觀察其近期有效率及不良反應是否有統(tǒng)計學意義,評價替莫唑胺及同步全腦放療的近期療效和安全性,以及是否能為腦轉(zhuǎn)移瘤患者提供最佳的治療方案,提高病人生活質(zhì)量。結(jié)果:經(jīng)比較,兩組患者的年齡、性別、KPS評分、原發(fā)腫瘤部位、病理類型、以及其他器官的轉(zhuǎn)移情況差異均無統(tǒng)計學意義(P0.05);兩組患者腦轉(zhuǎn)移瘤的數(shù)目、發(fā)現(xiàn)情況及腦轉(zhuǎn)移部位差異均無統(tǒng)計意義(P0.05),觀察兩組有效率及控制率得出結(jié)果:(1)同步放化療組患者治療有效率較單純放療組的患者有升高趨勢,但是差異無計學意義(P0.05);同步放化療組患者疾病控制率較單純放療組中的病人顯著升高(P0.05);(2)腦轉(zhuǎn)移瘤病人的放化療后的毒副反應的組織器官分類表現(xiàn)為血象異常、胃腸功能紊亂、皮膚、肝腎功能異常等,血小板和白細胞計數(shù)降低、脫發(fā)、惡心嘔以及頭暈頭痛是最常見的不良事件,但是兩組各項不良事件的發(fā)生頻率和嚴重程度差異均無統(tǒng)計學意義(P0.05)。結(jié)論:(1)全腦放療同步替莫唑胺化療治療腦轉(zhuǎn)移瘤較單純?nèi)X放療可顯著改善腦轉(zhuǎn)移瘤的近期療效;(2)全腦放療同步替莫唑胺化療和單純?nèi)X放療治療腦轉(zhuǎn)移瘤具有相似的安全性,毒副反應可以耐受。
[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.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.41

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