Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme:: results of a phase II prospective trial
Accelerated fractionated proton/photon irradiation to 90 cobalt gray equivalent for glioblastoma multiforme:: results of a phase II prospective trial
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DOI：
10.3171/jns.1999.91.2.0251
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发表时间：
1999-08-01
影响因子：
4.1
通讯作者：
Harsh, GR
中科院分区：
文献类型：
--
作者：
Fitzek, MM;Thornton, AF;Harsh, GR
目的。在常规剂量 55 至 65 Gy 的分段照射后，多形性胶质母细胞瘤 (GBM) 通常会在其原始位置复发。这项机构 II 期研究旨在评估在加速分割中使用共形质子和光子将剂量升级至 90 钴灰当量 (CGE) 是否会改善局部肿瘤控制和患者生存。方法。二十三名患者参加了这项研究。入选标准包括年龄在 18 岁至 70 岁之间、卡诺夫斯基表现量表评分大于或等于 70、残余肿瘤体积小于 60 mi、幕上单侧肿瘤。 2 年和 3 年精算生存率分别为 34% 和 18%。中位生存时间为 20 个月，其中 4 名患者在诊断后存活 22 至 60 个月。放射治疗肿瘤学组预后标准或医学研究委员会指数的分析显示，与接受传统治疗的患者相比，中位生存时间延长了 5 至 11 个月。所有患者在随访期间都出现了新的钆增强区域。对 23 名患者中的 15 名患者进行了活检、切除或尸检中获得的组织的组织学检查。仅 7 名患者出现放射性坏死，其生存期明显长于肿瘤复发患者 (p = 0.01)。肿瘤再生最常见于接受 60 至 70 CGE 或更少剂量的区域； 90-CGE体积中仅发现1例肿瘤复发。结论。加速分割中 90 CGE 的剂量几乎在所有病例中都预防了中枢性复发。中位生存时间延长至 20 个月，可能是中央控制的结果。肿瘤通常会在紧邻该 90-CGE 体积的外围区域复发，但通过扩大中央体积来扩大局部控制的尝试可能会因放射性坏死的困难而受到限制。
Object. After conventional doses of 55 to 65 Gy of fractionated irradiation, glioblastoma multiforme (GBM) usually recurs at its original location. This institutional phase II study was designed to assess whether dose escalation to 90 cobalt gray equivalent (CGE) with conformal protons and photons in accelerated fractionation would improve local tumor control and patient survival.Methods. Twenty-three patients were enrolled in this study. Eligibility criteria included age between 18 and 70 years, Karnofsky Performance Scale score of greater than or equal to 70, residual tumor volume of less than 60 mi, and a supratentorial, unilateral tumor.Actuarial survival rates at 2 and 3 years were 34% and 18%, respectively. The median survival time was 20 months, with four patients alive 22 to 60 months postdiagnosis. Analysis by Radiation Therapy Oncology Group prognostic criteria or Medical Research Council indices showed a 5- to 11-month increase in median survival time over those of comparable conventionally treated patients. All patients developed new areas of gadolinium enhancement during the follow-up period. Histological examination of tissues obtained at biopsy, resection, or autopsy was conducted in 15 of 23 patients. Radiation necrosis only was demonstrated in seven patients, and their survival was significantly longer than that of patients with recurrent tumor (p = 0.01). Tumor regrowth occurred most commonly in areas that received doses of 60 to 70 CGE or less; recurrent tumor was found in only one case in the 90-CGE volume.Conclusions. A dose of 90 CGE in accelerated fractionation prevented central recurrence in almost all cases. The median survival time was extended to 20 months, likely as a result of central control. Tumors will usually recur in areas immediately peripheral to this 90-CGE volume, but attempts to extend local control by enlarging the central volume are likely to be limited by difficulties with radiation necrosis.