Therapeutic effect of thalidomide combined with temozolomide and three-dimensional conformal radiotherapy for patients with high-grade gliomas after operation.

Purpose: Purpose: To investigate the clinical therapeutic effect and safety of thalidomide combined with temozolomide (TMZ) and three-dimensional conformal radiotherapy for patients with high-grade gliomas after operation.

Methods: Methods: The clinical data of 108 patients with high-grade gliomas undergoing operation in our hospital from September 2014 to December 2016 were retrospectively analyzed, of which 54 received thalidomide combined with TMZ and three-dimensional conformal radiotherapy (thalidomide group) and 54 received TMZ combined with three-dimensional conformal radiotherapy (control group). The clinical data of all patients were collected, and the short-term therapeutic effect, adverse reactions after treatment and quality of life scores were compared between the two groups of patients. Thereafter, the level of serum immune factors of the patients was recorded, and the overall survival (OS) rate and progression-free survival (PFS) rate of the patients were followed up and recorded.

Results: Results: The therapeutic effect was evaluated in all the patients at 1 month after treatment. It was found that the overall response rate (ORR) in thalidomide group [68.5% (37/54)] was markedly higher than that in control group [44.4% (24/54)] (p=0.012), but the difference in the disease control rate (DCR) between thalidomide group [92.6% (50/54)] and control group [83.3% (45/54)] was not statistically significant (p=0.139). After treatment, the scores of 36-Item Short Form Health Survey (SF-36) evaluating the quality of life in thalidomide group were higher than that in control group, in which the physical function score was statistically significantly different between the two groups (p=0.028), whereas the scores of the other items did not statistically significantly differ between the two groups (p>0.05). Following treatment, the levels of serum hepatocyte growth factor (HGF), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-17, vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) were remarkably reduced in the two groups of patients, and these indexes in thalidomide group were lower than those in control group after treatment. Among them, HGF (p=0.069), TNF-α (p=0.076), IL-6 (p=0.149) and IL-17 (p=0.114) showed no statistically significant differences, but VEGF and EGF were statistically significantly different between the two groups (p<0.001). Moreover, adverse reactions were mainly manifested as myelosuppression, nausea and vomiting, constipation, liver function injury, drowsiness and neurotoxicity (grade I-II in most cases), which returned to normal after symptomatic treatment. Besides, the incidence rate of drowsiness of the patients in thalidomide group was notably lower than that in control group (p=0.029), but the difference in the incidence rate of other manifestations was not statistically significant (p>0.05). Additionally, the follow-up results manifested that the median OS was (16.1±3.6) months, (12.8±3.9) months, respectively, and the median PFS was (9.0±3.2) months and (12.3±3.4) months, respectively, in thalidomide group and control group. Furthermore, log-rank test revealed that the patients in thalidomide group had longer OS (p=0.025) and PFS (p=0.040) than those in control group.

Conclusions: Conclusions: The application of thalidomide combined with TMZ and three-dimensional conformal radiotherapy for high-grade glioma patients after operation can prominently enhance the clinical therapeutic effect, improve patient quality of life, prolong survival, and produce tolerable adverse reactions.