邱幸生, 谢德荣, 刘宜敏, 薛卫平, 白守民. 低分割推量照射治疗43例幕上胶质母细胞瘤[J]. 中国肿瘤临床, 2009, 36(1): 22-24. DOI: 10.3969/j.issn.1000-8179.2009.01.007
引用本文: 邱幸生, 谢德荣, 刘宜敏, 薛卫平, 白守民. 低分割推量照射治疗43例幕上胶质母细胞瘤[J]. 中国肿瘤临床, 2009, 36(1): 22-24. DOI: 10.3969/j.issn.1000-8179.2009.01.007
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QIU Xingsheng, XIE Derong, LIU Yimin, XUE Weiping, BAI Shoumin. Hypofractionated Conformal Radiotherapy Boost for Primary Supratentorial Glioblastoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2009, 36(1): 22-24. DOI: 10.3969/j.issn.1000-8179.2009.01.007
Citation: QIU Xingsheng, XIE Derong, LIU Yimin, XUE Weiping, BAI Shoumin. Hypofractionated Conformal Radiotherapy Boost for Primary Supratentorial Glioblastoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2009, 36(1): 22-24. DOI: 10.3969/j.issn.1000-8179.2009.01.007
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低分割推量照射治疗43例幕上胶质母细胞瘤

Hypofractionated Conformal Radiotherapy Boost for Primary Supratentorial Glioblastoma

    摘要
  • 摘要: 目的：观察幕上胶质母细胞瘤术后常规分割照射后行低分割推量照射的疗效，分析影响生存的预后因素。方法：回顾性分析2001年12月至2005年12月行低分割推量照射治疗的43例原发性幕上胶质母细胞瘤患者的临床资料，均为单发病灶的初治患者，经手术切除或病理活检证实。采用适形照射技术，靶区包括残留灶、术后空腔及周围水肿区，根据治疗计划剂量分布特征及临近敏感器官限制剂量，设定靶区分割剂量与总照射剂量，周边水肿区常规分割剂量照射54～60Gy后，采用逐步缩野技术、个体化低分割推量照射，术后残留灶照射剂量超过70Gy。治疗结束后定期复查，观察生存得益及神经毒性反应，分析影响生存的预后因素。结果：全组中位生存时间14个月，1 年、2 年生存率分别为61% 、25% ，中位无进展生存时间为11个月，1 年、2 年无进展生存率分别为35％、11％。急性期神经毒性反应轻微，7 例发生1 级神经毒性，3 例发生后期2 级神经毒性反应，表现为中度头痛，9 例后期发生照射区域脑坏死，其中5 例经术后病理学诊断证实，4 例符合临床脑坏死诊断。多因素分析提示KPS 评分（P=0.002）、切除程度（P=0.025）及年龄（P=0.030）是影响生存的独立预后因素。结论：术后低分割推量照射是幕上胶质母细胞瘤的安全、有效的治疗手段。

     

    Abstract: Objective: To investigate the efficacy of hypofractionated conformal radiotherapy boost after post-operative conventional radiotherapy for supratentorial glioblastoma and to evaluate correlated factors for prognosis. Methods:A total of43patients with glioblastoma treated between December2001 and December 2005 were retrospectively reviewed. These patients had been recently diagnosed with a unifocal lesion of su-pratentorial glioblastoma and were treated with a hypofractionated conformal radiotherapy boost after conven-tional radiotherapy. The target area covered the residual tumor lesion, surgical cavity and surrounding edema. The fraction dose and total dose were tailored to the target volume with a three-step cone-down technique ac-cording to the dose profile of the treatment plan and dose limit of the adjacent tissues. The prescription dose to the edema of the surrounding tissues and residual tumor lesion exceeded 54Gy and70Gy, respectively. Kaplan-Meier method was used to analyze survival and progression-free survival. Acute and late neurological toxicities were graded according to Radiation Therapy Oncology Group neurotoxicity scores. Multivariate anal -yses were performed to determine significant prognostic factors. Results: The median overall survival was 14 months. The overall 1- and 2-year survival rates were 61% and 25% , respectively. The median time to dis-ease progression was 11months. The 1- and 2-year progression-free survival rates were 35% and 11%, re-spectively. Seven patients experienced grade 1 acute neurotoxicity and 3 patients suffered from headache due to grade 2 late neurotoxicity. Nine patients developed brain necrosis in the irradiation area, of which 5 were confirmed by surgical reexcision. Multivariate analyses showed that Karnofsky Performance Scale score (P=0.002 ), extent of resection (P=0.025 ) and age (P=0.030 ) were independent factors correlated to progno -sis. Conclusion:Hypofractionated conformal radiotherapy boost after post-operative conventional radiotherapy is safe and effective for treatment of supratentorial glioblastoma.

     

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