| Glioma is the most common primary intracranial tumors, but also the highest-grade brain tumor, accounting for all brain tumors in 37% -52.4%. WHO on the new classification of brain tumors will oligodendroglioma and ependymoma identified as moderately malignant tumors, most were classified as WHO gradeâ…¡andâ…¢of the class, a small number of specific parts of ependymoma WHOâ… level as . Glioma gradeâ…¡andâ…¢level primarily on the basis of whether or not mitotic, division of vascular proliferation and necrosis, there is no class forâ…¡, there shall be a three-classâ…¢. Will generally be clinically divided into low-grade glioma and high-level 2. LGGs refers to the pathological type ofâ… ~â…¡grade glioma include: astrocytoma, hair and fat-cell astrocytoma, glioma cells and fewer sticks Ganglioneuroma; and high-grade gliomas refers to the pathological typeâ…¢~â…£grade gliomas, including: glioblastoma, anaplastic small cell tumor of sticks, anaplastic astrocytoma, pleomorphic glial cells into myeloid cells into tumor and tumor, etc. . The study found different in nature or biological characteristics of glioma prognosis larger difference in treatment there are high recurrence rate, high morbidity, high mortality problem. Has been for the treatment of malignant gliomas program comes down to surgery, postoperative adjuvant radiotherapy and chemotherapy, anti-brain tumor chemotherapy drugs preferred alkylating agent, alkylating agent, however, before the major side effects of drugs, poor absorption, permeability have poor blood-brain barrier and easily with the plasma protein binding, and therefore achieve the tumor when it is difficult to maintain the plasma concentration. Temozolomide as a second- generation alkylating agent anti-tumor drug, is a broad-spectrum antitumor agents, cell cycle non-specific drugs, oral convenient, completely absorbed, bioavailability close to 100%, side effects. Through basic experimental research and clinical studies have demonstrated that temozolomide increased pleomorphic glioblastoma or astrocytoma deformation between the survival rate of patients, quality of life in patients with glioma extended progression-free survival period and reduce the relapse the rate of disability and mortality. The drug from the market in the United States in 1999, proved to be a significant clinical effect. At the same time, however, also brought some new problems, found that some patients with clinically certain of its resistance, there are reports abroad oral temozolomide combined cases of TB, but because temozolomide side effects, the larger dosage, the application of hormone or the tumor itself, lead to decrease in patients with resistant organisms. Another found that some clinical LGGs trend with malignant transformation, LGGs including a variety of different types of tumor, the tumor biological behavior between the clinical manifestations and prognosis of the differences are significant. The molecular level from the perspective of further study of Temozolomide treatment of glioma indication, drug resistance, rational drug use seems inevitable. More current research, including MGMT and temozolomide resistance, as well as the relationship between the Ki-67 assessment of malignant glioma and determine the prognosis of proliferation significance. Based on this, from the perspective of evidence-based medicine to a large number of randomized controlled prospective clinical study to allow for including patients with malignant transformation to improve the survival rate of LGGs, quality of life and prolong progression-free survival time, reduce the relapse rate, disability and death rate has an important bearing onObjective: To analyze the brain glioma at all levels between the Ki-67, MGMT, as well as any significant difference between Ki-67 and whether the correlation between MGMT and further explore the Ki-67 with malignant gliomas the link between and to explore the treatment of temozolomide efficacy glioma, such as reference dose for clinical treatment.Methods: The clinical data from the First Hospital of Jilin University 2003.12-2008.12 neurosurgery clinical data are complete and confirmed by surgery and pathology of 127 cases of glioma patients, of which 72 cases of male, female 55 cases, male / female ratio was 1.31: 1, men slightly more than women. Age range 2-75 years old, average 38.58 years old. Pathological examination: The purpose of this study strictly according to the World Health Organization (WHO) issued in 2000 on the criteria for the classification of intracranial tumor, for each of the tumor specimens of patients assessed and do further defined by immunohistochemistry of histological types of tumors. SPSS13.0 statistical methods used in each group of statistical software to analyze data in order to observe whether or not statistically significant.Results:1. Used for the Jonckheere-Terpstra test data in an orderly way:(1) after a statistical analysis shows that temozolomide treatment of glioma was no significant effect.(2). By statistical analysis of Ki-67 in glioma patients at all levels between the difference was significant, Ki-67 expression in glioma grading and the existence of a linear relationship, that is, with the classification by large, Ki-67 expression also increased.(3). The study found the expression of MGMT with glioma grading had no significant linear relationship.2. Derived using Spearman correlation coefficient: correlation coefficient rs = 0.646, P <0.001, MGMT and Ki-67 expression with statistical significance.Conclusion:1. In this paper, confirmed that Ki-67 in glioma among different levels were significantly different, that is, with the extent of malignant glioma, so as to assess the treatment of temozolomide glioma effect, indications of the reference 1.2. In this paper, studies have shown positive expression rate of MGMT glioma grading with no significant linear relationship shows that the positive rate of MGMT and gliomas grade was no significant correlation with glioma grade no significant correlation, and statistical analysis showed oral temozolomide at all levels between glioma resistance no significant difference. The current inconsistencies in the conclusions reported in the literature need to be confirmed by further studies.3. In this paper, after a case of follow-up, statistical analysis Temozolomide treatment of gliomas, the results showed no significant effect. At present, there are reported in the literature of oral temozolomide in patients with worse overall than abroad, on the one hand, considering the small sample size, statistical errors when the inevitable; on the other hand, consider the reasons for the small dose. Therefore, how to calculate the temozolomide dosage to achieve a reasonable and efficient treatment of glioma requires further research, from the papers and a large number of research findings reported in the literature at home and abroad should look at the molecular level up, rather than merely by reference to the body surface area in patients with estimates, so the need for further study of evidence-based medicine.
|
PDF Full Text Request