| Objective:The purpose of this study was to analyze the clinical efficacy of postoperative radiotherapy and chemotherapy,and prognostic factors in patients with malignant gliomas,to provide reference as treatment and prognostic evaluation for these patients.Methods:A retrospective analysis of the First Affiliated Hospital of Dalian Medical University from January 2010 to September 2015 between the treated and complete information of 80 cases(84 cases in total,4 cases lost to follow up)of primary data of patients with malignant glioma,which alone radiotherapy(radiotherapy group)34 cases,radiotherapy combined with chemotherapy(chemoradiotherapy group)46 cases,48 were male,32 female patients,pathological grade III grade 33,IV grade 47.All patients had intracranial tumor complete or subtotal resection.Three dimensional conformal radiotherapy(3DCRT)or intensity modulated radiation therapy(IMRT)was performed at 4 weeks after operation,6MV X ray external radiation,95%PTV1 DT50Gy/2Gy/25F,95%PTV2 DT10Gy/2Gy/5F.The total dose of 60Gy,6 weeks to complete.The patients in the chemoradiotherapy group were treated with Temozolomide Capsules(TMZ),and the patients were treated with radiotherapy.The period of radiotherapy was 75mg/m2/days,daily use(intermittent radiotherapy).Sequential chemotherapy began at the end of the 4 week after radiotherapy,oral dose of 200mg/m2/day,even for a period of 5 days,stopping for a period of 23 days,for a period of 28 days,a total of 6 cycles.SPSS 24 software was used for statistical analysis,statistical median survival time and 1,2 year survival rate,to compare the effect of radiotherapy and radiotherapy combined with TMZ chemotherapy in two groups,and the incidence of adverse reactions during radiotherapy.Survival analysis was performed using Kaplan-Meier method.Analysis the related factors that may affect the malignant glioma tumor prognosis.Establishment of Cox risk regression model for multivariate analysis,to get the independent prognostic factors(P<0.05,there was significant difference).Results:1)Until the end of the follow-up,all the 80 cases in the whole group,53cases died,and 27 cases were alive.The median survival time was 23.9 months,the overall survival rates of land 2 year were 83.8%and 46.3%,respectively.In our analysis of the whole group,the median survival time of single radiotherapyand radiotherapy combined with TMZ were 21.9 months and 27.5 months(p=0.702),the difference was not statistically significant.2)Further subgroup analysis,patients with grade IV,radiotherapy group and chemoradiotherapy group of patients with the median survival time was 11.6 months and 23.9 months(p=0.018),the difference was statistically significant.In grade ? patients,radiotherapy group and chemoradiotherapy group the median survival time was 56.7 months and 40.4 months(p=0.707),the difference was not statistically significant.3)The main adverse reactions during radiotherapy were thrombocytopenia,white blood cell decrease,gastrointestinal reaction,general fatigue.Rradiotherapy combined with TMZ chemotherapy compared with radiotherapy alone,the incidence rate of adverse reactions was not significantly increase(p=1.000?0.474?0.447?0.780).4)On univariate analyses,there were significant differences in the median survival time in patients who aged<60 years or>60 years at the time of diagnosis(14.9 vs.38.7 month,p<0.001),pathology grade III or IV(56.7 vs.18.5 month,p<0.001),whether there were obvious edema around the tumor(20.9 vs.49.6 month,p=0.025),the KPS score preoperative<70 or?70 points(35.6 vs.18.5,p=0.004),the extent of resection((27.5 vs.20.9 month,p=0.017),the tumor site(49.6 vs.23.6 month,p=0.026)and the number of the lesion(27.5 vs.16.7 month,p=0.042).Gender(p=0.937),preoperative neurologic symptoms(p=0.682),maximum tumor diameter(p=0.349),TMZ(p=0.702)with or without chemotherapy,surgery and radiotherapy time interval(p=0.965),radiotherapy mode(p=0.412),there was no significant difference in median survival time.5)By Cox regression model analysis,pathological grade(p=0.027),age(p=0.029)and preoperative KPS score(p=0.044),is the independent factors affecting the prognosis of malignant glioma.Conclusions:1)Compared with radiotherapy alone,radiotherapy combined with TMZ had significantly longer survival time in patients with grade ?.There was no significant survival benefit in patients with grade ?.2)Radiotherapy combined with TMZ chemotherapy did not increase the incidence of adverse reactions compared with radiotherapy alone..3)Age,pathological grading,severe peritumoral edema,preoperative KPS score,extent of resection,tumor location,tumor number,the above 7 factors are the significant factors affecting the median survival time of malignant glioma.Patients whose age<60 years,pathological grade in grade ?,preoperative KPS score more than 70 points,no obvious peritumoral edema,total tumor resection,tumor located in the frontal lobe and the lesion was single had a longer median survival time.4)Age,preoperative KPS score,pathological grading,the above three factors are the independent factors affecting the prognosis of malignant glioma. |
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