الفهرس 
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Abstract
Brain tumors comprise only 2% of all adult cancers but are among the most devastating malignancies. The most common type of a primary brain tumor, the malignant gliomas, almost invariably have a poor prognosis. Despite surgery, radiotherapy (RT) and chemotherapy, they grow rapidly, almost all patients ultimately recur and median survival is frequently less than 1 year with previously available agents, and approximately 15 months since the introduction of temozolomide (TMZ).
Forty-five patients with newly diagnosed, histopathologically documented, malignant gliomas constituted the clinical material of the present thesis.
Patients were randomized into:
Group I: Fifteen patients will receive radiotherapy.
Group II: Fifteen patients will receive concomitant temozolomide with radiotherapy.
Group III: Fifteen patients will receive radiotherapy followed by adjuvant temozolomide.
Our results revealed that:
- There was a statistical significant difference between the two histologies as regard the mean age.
- The majority of cases of glioblastoma multiform (21.19%) were between 50-59 years.
- Patients with glioblastoma multiform tended to have larger tumour sizes at presentation than patients with anaplastic astrocytoma. 87.1% of cases of glioblastoma multiforme had tumour sizes >3 cm while only 50% of cases of anaplastic-astrocytoma had tumour sizes more than 3 cm the difference in the size of the tumour between the two histologies showed a significant statistical difference.
- Patients receiving Radiotherapy concomitantly with Chemotherapy were between 24 to 72 years of age with a mean age of 47.40. While the mean ages for patients receiving Radiotherapy with adjuvant chemotherapy and those receiving radiotherapy only were 51.66 and 52.66 respectively with no statistical difference between the 3 groups.
- Comparing the 3 treatment groups no statistical significant difference was found as regards the sex distribution. There was no statistical significant difference between the 3 treatment groups as regard the size of the tumour before surgery and type of surgery done.
- The response to Radiotherapy is represented by the change in the tumour size after radiotherapy.
- Group I patients who received Radiotherapy concomitantly with temodal experienced decrease in the tumour size in 11 patients while in groups II and III, 7 cases experienced decrease in their tumour size. There was no significant difference among the three studied groups.
- After administration of adjuvant chemotherapy in group H the number of patients who experienced decrease in their tumour size became 9 instead of 7.
- Treatment toxicities in the three treatment groups are represented in Table XI.
- Lymphocytopenia was more common in group I occurring in 10 cases while nausea and vomiting were more evident in the second group who received adjuvant treatment.
- Treatment toxicities were least in the third treatment group who received Radiotherapy only.
- No difference in the survival rate at the end of the follow up period was encountered among the 3 treatment groups.
- Four patients in group I experienced no recurrence till the end of the follow up period representing 26.66% compared to 3 patients (20%) in group II and no patient (0%) in group II.
- As regard the numbers of cases who had late progression (after 1 year from presentation) in the three treatment groups, they were 7 (46.66%), 6 (40%) and & (46.66%) in groups I, II and III respectively.
- Studying the 3 treatment groups there was no significant difference among them as regards progression.
Thus, we concluded that:
- Temozolomide demonstrated a beneficial effect treatment of gliomas with minimal side effects.