本文選題：惡性膠質(zhì)瘤 + 放射治療　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析惡性腦膠質(zhì)瘤術(shù)后放化療的臨床療效以及相關(guān)預(yù)后因素,為惡性膠質(zhì)瘤患者治療方案的選擇和預(yù)后評(píng)價(jià)提供依據(jù)。方法:回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院放療科自2010年1月至2015年9月間收治并且資料齊全的80例(共84例,失訪4例)初發(fā)惡性腦膠質(zhì)瘤患者資料,其中單獨(dú)行放療者(單放組)34例,放療聯(lián)合化療者(放化組)46例,男性患者48人,女性患者32人,病理分級(jí)Ⅲ級(jí)者33人,Ⅳ級(jí)者47人。所有患者均行顱內(nèi)腫瘤完全或大部切除術(shù)。于術(shù)后4周左右始行三維適形放射治療(3DCRT)或調(diào)強(qiáng)放射治療(IMRT),6MV X線外照射,95%PTV150Gy/2Gy/25F;95%PTV2 10Gy/2Gy/5F�？倓┝� 60Gy,6 周完成。放化組患者化療方案均為口服替莫唑胺膠囊(TMZ),與放療同步、序貫或同步+序貫使用。同步放療期間為75mg/m2/日,每日服用(放療間歇不中斷)。序貫化療開始于放療結(jié)束4周后,口服劑量為200mg/m2/日,連服5天,停藥23天,28天為一個(gè)周期,共6個(gè)周期。應(yīng)用SPSS 24.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,統(tǒng)計(jì)所有患者中位生存時(shí)間及1、2年生存率,比較單純放療和放療聯(lián)合TMZ化療兩組患者的療效差異,及放療期間兩組患者不良反應(yīng)的發(fā)生情況。采用Kaplan-Meier法進(jìn)行生存分析,分析可能影響惡性腦膠質(zhì)瘤預(yù)后的相關(guān)因素,并建立Cox風(fēng)險(xiǎn)回歸模型進(jìn)行多因素分析,得出獨(dú)立的預(yù)后影響因素(p0.05為差異有統(tǒng)計(jì)學(xué)意義)。結(jié)果:(1)至隨訪結(jié)束,全組80例患者,死亡53例,尚存活27例,中位生存時(shí)間為23.9個(gè)月,1、2年總生存率分別為83.8%、46.3%。全組患者整體分析中,單放組與放化組相比,兩組中位生存時(shí)間分別是21.9個(gè)月和27.5個(gè)月(p=0.702),差異無(wú)統(tǒng)計(jì)學(xué)意義。(2)進(jìn)一步亞組分析,Ⅳ級(jí)患者中,單放組和放化組患者中位生存時(shí)間分別為11.6個(gè)月和23.9個(gè)月(p=0.018),差異有統(tǒng)計(jì)學(xué)意義;Ⅲ級(jí)患者中,單放組和放化組患者中位生存時(shí)間分別為56.7個(gè)月和40.4個(gè)月(p=0.707),差異無(wú)統(tǒng)計(jì)學(xué)意義。(3)全組患者放療期間出現(xiàn)的不良反應(yīng)主要表現(xiàn)為血小板減少、白細(xì)胞總數(shù)下降、胃腸道反應(yīng)和周身乏力,放療同期聯(lián)合TMZ化療與單純放療組相比,不良反應(yīng)發(fā)生率無(wú)明顯差異(p值分別為1.000、0.474、0.447、0.780)。(4)單因素分析:以下因素經(jīng)log-rank檢驗(yàn),年齡≥60歲與60歲(14.9 vs.38.7個(gè)月,p0.001)、病理分級(jí) Ⅲ 級(jí)與 Ⅳ 級(jí)(56.7 vs.18.5 個(gè)月,p0.001)、術(shù)前是否有重度瘤周水腫(20.9vs.49.6個(gè)月,p=0.025)、術(shù)前KPS評(píng)分≥70分與70 分(35.6vs.18.5 個(gè)月,p=0.004)、切除程度(27.5vs.20.9 個(gè)月,p=0.017)、腫瘤部位(49.6 vs.23.6 個(gè)月,p=0.026)、病灶個(gè)數(shù)(27.5 vs.16.7 個(gè)月,p=0.042),其中位生存時(shí)間差異有統(tǒng)計(jì)學(xué)意義。而性別(p=0.937)、術(shù)前有無(wú)神經(jīng)癥狀(p=0.682)、腫瘤最大徑(p=0.349)、有無(wú)TMZ化療(p=0.702)、手術(shù)與放療時(shí)間間隔(p=0.965)、放療方式(p=0.412),其中位生存時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義。(5)多因素分析:建立COX風(fēng)險(xiǎn)回歸模型,病理分級(jí)(p=0.027)、年齡(p=0.029)和術(shù)前KPS評(píng)分(p=0.044),是惡性腦膠質(zhì)瘤獨(dú)立的預(yù)后影響因素。結(jié)論:(1)放療聯(lián)合TMZ化療與單純放療相比,可使Ⅳ級(jí)腦膠質(zhì)瘤患者中位生存期顯著延長(zhǎng),但對(duì)Ⅲ級(jí)患者中位生存期的影響不明顯。(2)放療同期聯(lián)合TMZ化療與單獨(dú)放療相比未增加患者不良反應(yīng)發(fā)生率。(3)年齡、病理分級(jí)、是否有重度瘤周水腫、術(shù)前KPS評(píng)分、切除程度、腫瘤部位、病灶個(gè)數(shù),以上7個(gè)因素是影響惡性腦膠質(zhì)瘤患者中位生存時(shí)間的顯著因素,年齡60歲、病理分級(jí)Ⅲ級(jí)、無(wú)重度瘤周水腫、術(shù)前KPS評(píng)分≥70分、腫瘤全切、腫瘤位于額葉、病灶單發(fā)者中位生存時(shí)間較長(zhǎng),預(yù)后較好;(4)年齡、病理分級(jí)、術(shù)前KPS評(píng)分是惡性腦膠質(zhì)瘤預(yù)后的獨(dú)立影響因素。
[Abstract]:Objective: to analyze the clinical efficacy and prognostic factors of postoperative radiotherapy and chemotherapy for malignant glioma, and to provide basis for the selection and prognosis evaluation of the patients with malignant glioma. Methods: a retrospective analysis of 80 cases (84 cases) from January 2010 to September 2015, the First Affiliated Hospital of Dalian Medical University, which were admitted from January 2010 to September 2015. 4 cases of primary malignant glioma were reported, including 34 cases of single radiotherapy (single radiotherapy), 46 cases of radiotherapy combined with chemotherapy (chemoradiotherapy group), 48 male patients, 32 female patients, 33 histopathological grade III and 47 of grade IV. All patients underwent complete or large resection of intracranial swelling tumor. Three dimensional conform began about 4 weeks after the operation. Radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT), 6MV X-ray external irradiation, 95%PTV150Gy/2Gy/25F; 95%PTV2 10Gy/2Gy/5F. total dose 60Gy, 6 weeks complete. The chemotherapy regimen of the chemoradiation group were all oral Temozolomide Capsules (TMZ), synchronized with radiotherapy, sequential or simultaneous + sequential use. Sequential chemotherapy started at 4 weeks after the end of radiotherapy. The oral dose was 200mg/m2/ days, even 5 days, 23 days and 28 days as a cycle, with a total of 6 cycles. Statistical analysis was carried out with SPSS 24 software. The median survival time and 1,2 survival rate of all patients were statistically compared with those of two groups of patients with the combination of radiotherapy and radiotherapy combined with radiotherapy combined with TMZ chemotherapy. Differences, and the occurrence of adverse reactions in the two groups of patients during the radiotherapy. The survival analysis was carried out by the Kaplan-Meier method, the factors that might affect the prognosis of malignant glioma were analyzed, and the Cox risk regression model was established for multiple factors analysis to obtain the independent prognostic factors (P0.05 was statistically significant). Results: (1) to follow-up At the end, there were 80 patients in the whole group, 53 cases of death and 27 cases of survival, the median survival time was 23.9 months and the total survival rate of 1,2 years was 83.8%. In the whole group analysis of 46.3%. group, the median survival time of the two groups was 21.9 months and 27.5 months respectively (P =0.702), respectively. (2) further subgroup analysis, IV Among the patients, the median survival time was 11.6 months and 23.9 months (p=0.018), respectively. The median survival time was 56.7 months and 40.4 months (p=0.707), respectively. (3) the adverse reaction occurred during the whole group. The main manifestations were thrombocytopenia, leukocyte count decline, gastrointestinal reaction and body fatigue. The incidence of adverse reactions was not significantly different (P value 1.000,0.474,0.447,0.780, respectively) compared with the radiotherapy group (1.000,0.474,0.447,0.780). (4) single factor analysis: log-rank test with lower factors, age above 60 years and 60 years (14.9 vs.38.7) A month, p0.001), pathological grade III and IV (56.7 vs.18.5 months, p0.001), had severe peritumoral edema (20.9vs.49.6 months, p=0.025) before operation, before operation, KPS score was more than 70 points and 70 (35.6vs.18.5 months, p=0.004), the degree of resection (27.5vs.20.9 months, p=0.017), tumor site (49.6 vs.23.6 month, p=0.026), and the number of lesions (27.5) S.16.7 months, p=0.042), the survival time difference was statistically significant. And sex (p=0.937), there were no neurologic symptoms (p=0.682), tumor maximum diameter (p=0.349), TMZ chemotherapy (p=0.702), operation and radiotherapy interval (p=0.965), radiotherapy formula (p=0.412), and there was no statistical significance for the difference of survival time. (5) multivariate analysis: Construction COX risk regression model, pathological grading (p=0.027), age (p=0.029) and preoperative KPS score (p=0.044) are independent prognostic factors of malignant glioma. Conclusion: (1) radiotherapy combined with TMZ chemotherapy and radiotherapy alone can significantly prolong the median survival of patients with grade IV glioma, but the impact on the median survival of grade III patients is unclear. (2) (2) the incidence of adverse reactions was not increased by combined radiotherapy combined with radiotherapy alone. (3) age, pathological grading, severe peritumoral edema, preoperative KPS score, resection degree, tumor location, number of lesions, and the above 7 factors are significant factors affecting the median survival time of patients with malignant glioma, age 60, pathology Grade III, no severe peritumoral edema, preoperative KPS score was more than 70 points, tumor was completely cut, tumor was located in frontal lobe, the median survival time was longer and prognosis was better, and (4) age, pathological grading, and preoperative KPS score were independent factors of prognosis of malignant glioma.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.41
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本文編號(hào)：1949009