| Background and purposeGlioma is the most common primary tumor, accounts for about 40%～45% in intracranial neoplasm. Because most gliomas cells are invasive into normal tissue, without apparent boundary, which increased difficulties in glioma treatment. The current glioma is not optimistic the prognosis of malignant glioma. Especially the average survival time was still not more than 1 year, and highly malignant multiforme 5-year survival rate is less than 5 percent. How to improve the clinical treatment effect of glioma is the important direction in oncology field. Astrocytomas is one of the most common Brain gliomas.Ⅲ-Ⅳastrocytomas are considered highly malignant glioma.At present, the basic gliomas treatments are surgery, radiotherapy and chemotherapy. Because of the growth characteristics of the high-level glioma, it is difficult to be cured by surgery, and postoperative radiotherapy and chemotherapy also become necessary for the high grade glioma treatment. But any single means could not achieve real cure for the high grade glioma. So making treatment strategyies for glioma treatment, We take "surgery+radiotherapy + chemotherapy" Comprehensive treatment strategies, which is a better realistic choice.Glioma surgery should utmost cut diseased tissue and protect normal tissue and functions. With the progression of radiation therapy equipment and technologies, currently 3 dimensional comformal radiation therapy (3D- CRT) instead of rectangular wild illuminate, which utmost focus the dose of radiation treatment on the tumor site, thereby reduce lesions surrounding normal tissues and organs or receive few unnecessary illuminate, and greatly reduce the adverse reaction by radiotherapy. The Nitrosourea drugs are usually used chemotherapy drugs for Glioma treatment and These drugs can go through the blood brain barrier, and are toxic for each period of tumor cells, but such drugs have obvious adverse reactions to patients. So the gastrointestinal reaction and the arrest of bone marrow limit their use for a long time. Fotemustine is the third generation of Nitrosourea drugs which is a modified and nitro in structure monomer (VCM), and increased cammonia phosphate. Its low molecular weight and highly fat-soluble make it easier to go through the blood brain barrier and shows bi-active by ammonia formex and alkylation agent. And it can show off its anti-tumor effect. In recent years the new radiation technologies, the emergence of new drugs, which greatly improved treatment effects of malignant glioma.which brings hope for malignant glioma patients.MethodSelected 81 gliomas patients from March 2002 to March 2005 in the first affiliated hospital of Zhengzhou University, and these patients were all proved to be: III leves star cell tumor by postoperative pathologic,and the patient age are from 20 to 68 years old, in them male:39, female:42. After 2～4 weeks of operation these patients were divided into A and B two groups, and accepted different treatment.group A accepted pure radiation and group B accepted chemoradiation (the agent is Fotemustine). After therapy reviewed headed enhance MRI on 1.5,3 and 6 months respectively, and Compared to data of two groups, observed short-term curative effect and adverse reactions in two groups. Meier method to calculate Kaplan survival rates by X-ray. The data was performed by x2test using SPSS version 17.0. The differences was considered statistically significant when P<0.05.Results1. Compared A to B by observing short-term curative effect and adverse reactions, and the differences are significant in statistics after 1.5,3 and 6 months of treatment.2. Compared A to B by suvival rate after 1,2,3 years of treatment,and group A higher than group B, And the differences are nonsignificant in statistics(P> 0. 05).3. The main adverse reactions of two groups are arrest of bone marrow, headache, nausea, emesis, and craniocerebral injury. Appeared overⅡdegree bone marrow inhibition rate of 6.8% in group A, and 27.8% in group B, and the differences are significant in statistics (P< 0.05).And both groups were not found significant abnormal of liver, kidney function.conclusion1. The therapy of the fotemustine combined with radiation was superior to radiotherapy alone, by comparison of the relatively recent and the long-term efficacy. There is significant differences between the two groups.2. The group of radiotherapy combined with chemotherapy is severer than radiotherapy alone group in overⅡdegrees of bone marrow suppression. There is significant differences between the two groups (P<0.05). But it does not affect the radiotherapy process after symptomatic treatment. |
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