摘要
背景与目的:星形细胞瘤是神经系统最常见的难治性肿瘤,约占神经上皮肿瘤的75%,具有发生率高、残废率高、复发率高和治愈率低的特点。对星形细胞瘤规范的个体化综合治疗是提高其疗效的希望和努力方向。本研究对62例星形细胞瘤患者行个体化显微手术治疗,术后依据肿瘤特点和病理级别行个体化辅助放/化疗,以探讨个体化综合治疗星形细胞瘤的效果。方法:研究组62例星形细胞瘤患者采用个体化治疗方案:(1)个体化显微手术;(2)个体化放疗;(3)个体化化疗(参考药敏实验)。对照组50例星形细胞瘤患者治疗模式为:常规手术+局部外放疗+BCNU化疗。研究组62例患者术后病理学诊断为星形细胞瘤Ⅱ级19例、Ⅲ级32例、Ⅳ级11例;接受局部外放疗59例、接受化疗46例。对照组50例患者术后病理学诊断为星形细胞瘤Ⅱ级13例、Ⅲ级28例、Ⅳ级9例;接受BCNU化疗+局部外放疗的31例、接受局部外放疗+BCNU化疗的19例。平均随访25.8月,以影像学结果、KPS评分和生存率判定两组患者的疗效。结果:研究组肿瘤全切率为67.7%,对照组肿瘤全切率为58.0%;采用两种治疗模式治疗后低级别星形细胞瘤患者的KPS评分和生存率无显著差异;高级别星形细胞瘤采用个体化治疗模式显著改善了患者的生存,2年预期生存率研究组Ⅲ级为93.7%,Ⅳ级为36.3%;对照组Ⅲ级为67.
BACKGROND &OBJECTIVE: Astrocytomas, constitute ahout 75%of neur oe pithelial tumors, is one of the most common primary tumors in central nervous sy stem with fairly high incidence and poor prognosis. Individualized multimodality is the hope for improving prognosis of patients with astrocytoma. This study wa s designed to investigate the efficiency of individualized treatment of microsur gery, radiotherapy, and chemotherapy for 62 patients with astrocytoma. METHODS: Sixty-two patients with astrocytoma in study group were treated with individual ized multimodality of microsurgery, postoperative radiotherapy, and/or postopera tive chemotherapy according to in vitro sensitivity assay. After microsurgery, 5 9 patients accepted radiotherapy, 46 patients received chemotherapy. Fifty patie nts with astrocytoma in control group were treated with conventional treatment o f surgery, chemotherapy, and radiotherapy.After surgery, 31 patients received ra diotherapy following by BCNU chemotherapy, while 19 patients accepted BCNU chemo therapy following radiotherapy. Pathologic diagnosis of patients in study group were 19 cases of grade,32 cases of grade Ⅲ, and 11 cases of grade Ⅳ; in contr ol group were 13 cases of grade Ⅱ, 28 cases of grade Ⅲ,and 9 cases of grade Ⅳ . Mean follow-up time were 25.8 months, and the outcome was evaluated by MRI, K PS, and survival rate. RESULTS: Tumor total resection rate in study group was 67 .7%, while that in control group was 58.0%. There was no significant differenc e of KPS and survival rate in patients with low-grade astrocytoma between 2 gro ups, while the outcome of patients with malignant astrocytoma was significantly improved by individualized treatment. In study group, 2-year expectant survival rate of patients with astrocytoma of grade Ⅲ, and grade IV were 93.7%, and 36 .3%, while in control group were 67.5%, and 22.2%(P< 0.05). In glioblastoma p atients, median survival time of study group was 18.68 months, while that of con trol group was 12.83 months (P< 0.01). CONCLUSION: Individualizd microsurgery ma y improve the total resection of astrocytoma, and benefit to postoperative treat ment.Individualized radiotherapy/chemotherapy may prevent patients from some com plications. Individualied management may improve progngsis of patients with astr ocytoma, particularly malignant astrocytoma.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2004年第z1期1555-1560,共6页
Chinese Journal of Cancer
基金
国家自然科学基金项目(No.30271329)
中山大学重点学科建设项目
CMB基金(98-677)~~
关键词
星形细胞瘤
显微手术
放疗
化疗
Astrocytoma
Microsurgery
Radiotherapy
Chemotherapy
Outcome
