尼莫斯汀联合顺铂持续灌注化疗治疗25例复发性胶质母细胞瘤

Chemotherapy with Continuous Intravenous Infusion of ACNU with Cisplatin in Patients with Recurrent Glioblastoma: A Retrospective Analysis

  • 摘要: 目的:评价尼莫司汀(ACNU)联合顺铂(CDDP)72h 持续灌注化疗治疗复发性胶质母细胞瘤的有效性及不良反应。方法:分析比较联合化疗组与替莫唑胺化疗组的疗效与不良反应。25例术后、放疗后复发的胶质母细胞瘤患者行ACNU 联合CDDP72h 持续静脉灌注化疗,36例胶质母细胞瘤患者单独接受替莫唑胺化疗。化疗后复查MRI 观察治疗效果,每周监测血常规及肝肾功能,及时处理化疗后的不良反应;随访患者生存时间。结果:联合化疗组肿瘤部分缓解(PR)14例(56%);病情稳定(SD)8 例(32%);肿瘤有进展(PD)3 例(12%)。 Ⅲ度以上白细胞降低的11例(44%),Ⅲ度以上血小板降低的14例(56%),经治疗均恢复,无治疗后死亡病例。联合化疗组短期疗效优于替莫唑胺组(P<0.05),1 年生存率两组之间的差异无统计学意义(P>0.05)。 结论:ACNU 联合CDDP 72h 灌注化疗治疗复发性胶质母细胞瘤是一种比较有效的补救治疗手段,化疗后严重的骨髓抑制可经治疗得到缓解。

     

    Abstract: Objective:To evaluate the efficacy and the toxicity of 1-( 4-amino-2-methyl- 5-pyrimidinyl )-methyl-3-( 2-cholroeth-yl )- 3-nitrosourea hydrochloride (ACNU)administered with cisplatin by intravenous infusion for 72h in patients with recurrent glio-blastoma. Methods:The efficacy and toxicity of ACNU and cisplatin combination chemotherapy were compared with those of temo -zolomide. Twenty-five patients with recurrent glioblastoma multiforme were treated with ACNU and cisplatin through intravenous infu -sion for 72h. Twenty-five patients with recurrent glioblastoma multiforme were treated with TMZ( temozolomide ). The treatment re -sponse was evaluated using magnetic resonance imaging ( MRI ). Complete blood counts, liver function test, and blood urea-nitrogen/creatinine were tested every week. If side effects occurred after chemotherapy, they were managed immediately. The living states of the patients were observed during the relatively long follow-up period. Results:Response to treatment was observed in 14patients ( 56% ), 8 patients ( 32% ) had stable disease ( SD ), and3 patients ( 12% ) showed progression ( PD ). Myelosuppression was severe ( grade Ⅲ/Ⅳleukopenia in 11 patients ( 44% ) and grade III/IV thrombocytopenia in 14patients ( 56% ), but most recovered after the chemothera-py cycles. There was no treatment-related death. The short-term effect of the ACNU and cisplatin combination chemotherapy was better than temozolomide therapy ( P < 0.05), but there was no significant difference in 1-year survival rate between the two groups ( P <0.05). Conclusion:ACNU and cisplatin chemotherapy can be an effective salvage therapy for recurrent glioblastoma patients. Severe myelosuppression by the chemotherapy regimen was the greatest side effect, but was manageable.

     

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