摘要
目的探讨不同治疗方案对脑胶质瘤脑脊液播散和脊髓播散患者生存期的影响。方法 2012年2月至2019年5月天津市环湖医院肿瘤放射治疗科共收治脑胶质瘤患者1 036例,回顾性分析其中34例出现脑脊液播散和(或)脊髓播散患者的临床资料。按治疗方案分组,支持组(5例)为仅接受对症处理和支持治疗的患者;基础组(15例)为仅接受放疗、化疗、放疗+化疗或仅靶向治疗的患者;综合组(14例)为患者同时接受放疗+化疗(含鞘内化疗),并联合靶向治疗者。收集患者的一般资料、肿瘤切除程度、病理学类型、世界卫生组织(WHO)分级、术后放疗和化疗方案、肿瘤出现播散时间、播散后治疗方案、播散后生存期等。比较不同组别间的临床资料。采用Kaplan-Meier法绘制生存曲线,比较3组间的播散后生存期是否存在差异。结果 3组患者年龄、性别、WHO分级、病理学类型、术中是否开放脑室、肿瘤是否临近脑室、治疗前Karnofsky功能状态评分的差异均无统计学意义(均P>0.05);3组患者的前期肿瘤切除程度和治疗后出现播散时间的差异均有统计学意义(均P<0.05)。34例患者的中位随访时间为19.4个月(2.9~93.2个月)。至末次随访,存活11例(32.3%),死亡23例(67.6%);其中,支持组的死亡比例为5/5,基础组为11/15,综合组为7/14。34例患者的播散后中位生存期为6.1个月(1.0~20.5个月)。支持组的播散后中位生存期为2.1个月(1.0~3.2个月),基础组的播散后中位生存期为5.9个月(2.5~20.5个月),综合组的播散后中位生存期为9.3个月(1.0~19.0个月),3组间播散后中位生存期的差异有统计学意义(χ2= 43.404,P<0.001)。结论放、化疗联合靶向治疗的综合治疗方案,可以有效地延长脑胶质瘤患者脑脊液和脊髓播散后的生存期。
Objective To investigate the effect of different treatment schemes on survival of patients with cerebrospinal fluid(CSF)dissemination and leptomeningeal dissemination of gliomas.Methods A total of 1036 patients were diagnosed with gliomas and admitted to Department of Radiotherapy,Tianjin Huanhu Hospital from February 2012 to May 2019.Among them,34 patients were diagnosed as CSF dissemination and/or leptomeningeal dissemination,whose clinical data were retrospectively analyzed in this study.The patients were divided into 3 groups based on the treatment schemes.The palliative treatment group(5 cases)consisted of patients who received only symptomatic and supportive treatment.Fundamental treatment group(15 cases)were patients who underwent radiotherapy,chemotherapy,radiotherapy plus chemotherapy or targeted treatment only.Comprehensive treatment group(14 cases)were patients who underwent simultaneous radiotherapy and chemotherapy(including intrathecal chemotherapy)combined with targeted therapy.We collected the general data of patients,tumor removal degree,pathological type,WHO rating,postoperative radiotherapy and chemotherapy scheme,tumor dissemination time,post-dissemination treatment regimen,post-dissemination survival(PDS),etc.The clinical characteristics of different groups were compared.The survival curve was drawn using the Kaplan-Meier method,and the survival periods of the 3 groups were compared.Results Among 3 groups,differences in the patient′s age,gender,WHO rating,pathological type,opening of the ventricle,proximity to the ventricle and pre-treatment KPS(Karnofsky Performance Status)score were not statistically significant(all P>0.05),while the resection degree of previous operation and time of postoperative dissemination were statistically significant(both P<0.05).The median follow-up time for 34 patients was 19.4 months(2.9-93.2 months).By the last follow-up,there were 11 cases of survival(32.3%)and 23 deaths(67.6%).Among them,all 5 cases(5/5)in the palliative treatment group died,11 deaths(11/15)were reported in the fundamental treatment group and 7 deaths(7/14)in the comprehensive treatment group.The median PDS of 34 patients was 6.1 months(1.0-20.5 months).The median PDS was 2.1 months(1.0-3.2 months)in palliative treatment group,5.9 months(2.5-20.5 months)in fundamental treatment group,and 9.3 months(1.0-19.0 months)in comprehensive treatment group.The difference in PDS between 3 groups was statistically significant(χ2=43.404,P<0.001).Conclusion Comprehensive treatment of radiation and chemotherapy combined with targeted therapy can effectively prolong the survival of glioma patients post CSF and leptomeningeal dissemination.
作者
郭阳
姜炜
王政
杜芳芳
孙亚方
王亚红
宋彬
任义
石祥宇
Guo Yang;Jiang Wei;Wang Zheng;Du Fangfang;Sun Yafang;Wang Yahong;Song Bin;Ren Yi;Shi Xiangyu(Department of Radiotherapy,Tianjin Huanhu Hospital,Tianjin 300051,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第9期941-946,共6页
Chinese Journal of Neurosurgery
关键词
神经胶质瘤
肿瘤治疗方案
分子靶向治疗
预后
播散
Glioma
Antineoplastic protocols
Molecular targeted therapy
Prognosis
Dissemination
作者简介
通信作者:姜炜,Email:wjianghh@163.com。
