本文選題：替莫唑胺 + 同期放化療　； 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:通過(guò)觀察口服替莫唑胺同步全腦放療后不序貫化療治療腦轉(zhuǎn)移瘤的近期療效、毒副反應(yīng)及生存率,用統(tǒng)計(jì)方法分析腦轉(zhuǎn)移瘤同步放化療后不序貫化學(xué)藥物治療的毒副反應(yīng),治療效果及1年生存率,總結(jié)適宜腦轉(zhuǎn)移瘤的個(gè)性化方案進(jìn)行治療。方法:收集2011年1月-2013年12月就診于我院腫瘤放療科的轉(zhuǎn)移性腦腫瘤患者,其中符合納入和排除標(biāo)準(zhǔn)的患者有40例。對(duì)病歷資料進(jìn)行詳細(xì)的統(tǒng)計(jì)分析,根據(jù)治療的方法不同進(jìn)行分組,可分為替莫唑胺同期放化療組(A組)和放療組(B組)。AB兩組患者均接受直線加速器6m V-X線全腦兩側(cè)對(duì)穿野等中心放射治療,DT30Gy/10次,5次/周。A組患者行全腦放射治療同時(shí)給予替莫唑胺每日75mg/m2口服治療,連續(xù)服用14d,完成放射治療時(shí),停止給藥。結(jié)果:替莫唑胺同期全腦放療組16例,其中男女患者比例12:4,年齡38-70歲(54.94±2.39);單純放療24例,其中男女患者比例15:9,年齡35-74歲(53.29±2.22)。本資料中,非小細(xì)胞肺癌為最主要的原發(fā)病來(lái)源(19例),其次是小細(xì)胞肺癌、乳腺腫瘤、胃腸道癌癥等;兩組患者腦內(nèi)轉(zhuǎn)移灶多為2-3個(gè)。以上兩組間資料經(jīng)卡方檢驗(yàn)(p值0.05)或t檢驗(yàn)(p0.05),均無(wú)統(tǒng)計(jì)學(xué)意義。替莫唑胺同期全腦放療與單純?nèi)X放療患者的白細(xì)胞、血紅蛋白、血小板降低的發(fā)生率分別為81.25%和45.83%、31.25%和20.83%、18.75%和12.5%,其中具有統(tǒng)計(jì)學(xué)意義的只有白細(xì)胞計(jì)數(shù)的下降;兩組患者的惡心、嘔吐發(fā)生率分別為87.5%和79.17%,p0.05無(wú)統(tǒng)計(jì)學(xué)差異;替莫唑胺同期全腦放療的頭痛發(fā)生率為75%,單純?nèi)X放療患者的頭痛發(fā)生率為83.33%,p0.05無(wú)統(tǒng)計(jì)學(xué)差異。替莫唑胺同期全腦放療組治療有效率為87.5%,其中完全緩解6例;單純?nèi)X放射性治療組治療有效率為54.17%,其中有3例完全緩解,統(tǒng)計(jì)值P0.05提示兩組間差別有意義。AB兩組患者的生存率分別為56.25%和29.17%,p0.05提示有差異。結(jié)論:轉(zhuǎn)移性腦瘤患者使用替莫唑胺聯(lián)合全腦放射治療(A組)的毒副反應(yīng)與單純放射治療(B組)相比,只有在白細(xì)胞計(jì)數(shù)中兩組間差異,p0.05提示有意義,但患者可耐受。A組的近期療效優(yōu)于B組,同時(shí)A組與B組相比顯著提高了患者的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 鹵2.39) and 24 patients with radiotherapy alone (15: 9 male / female, aged 35-74 years, 53.29 鹵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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R739.41

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本文編號(hào)：1890293