目的:评价尼莫司汀(ACNU)联合顺铂(CDDP)72 h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CDDP 72 h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 72 h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.%Objective: To evaluate the efficacy and the toxicity of 1-( 4-amino-2-methyl-5-pyrimidinyl )-methyl-3-( 2-cholroethyl )-3-nitrosourea hydrochloride (ACNU) administered with cisplatin by intravenous infusion for 72 h in patients with recurrent glioblastoma.Methods: The efficacy and toxicity of ACNU and cisplatin combination chemotherapy were compared with those of temozolomide.Twenty-five patients with recurrent glioblastoma multiforme were treated with ACNU and cisplatin through intravenous infusion for 72 h.Twenty-five patients with recurrent glioblastoma multiforme were treated with TMZ ( temozolomide ).The treatment response 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 14 patients ( 56％ ), 8 patients ( 32％ ) had stable disease ( SD ), and 3 patients ( 12％ ) showed progression ( PD ).Myelosuppression was severe ( grade Ⅲ/ Ⅳ leukopenia in 11 patients ( 44％ ) and grade III/IV thrombocytopenia in 14 patients ( 56％ ), but most recovered after the chemotherapy 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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