MALIGNANT ASTROCYTOMAS - FOCAL TUMOR RECURRENCE AFTER FOCAL EXTERNAL BEAM RADIATION-THERAPY
MALIGNANT ASTROCYTOMAS - FOCAL TUMOR RECURRENCE AFTER FOCAL EXTERNAL BEAM RADIATION-THERAPY
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DOI：
10.3171/jns.1991.75.4.0559
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发表时间：
1991-10-01
影响因子：
4.1
通讯作者：
GREENBERG, HS
中科院分区：
文献类型：
--
作者：
LIANG, BC;THORNTON, AF;GREENBERG, HS
Hochberg和Pruitt报道了90%的患者在全脑放疗后在原发部位2 cm内复发胶质母细胞瘤。 他们认为，计算机断层扫描（CT）的扫描精度将允许更小的辐射野。 本文报告一种手术切除后小野局灶性脑照射的治疗方案。 第一个4500 cGy的辐射集中在肿瘤周围3 cm的范围内，在1.5 cm的范围内增加1500 cGy。 回顾性分析了42例接受局灶性脑放射治疗的III级或IV级星形细胞瘤患者，以评估肿瘤复发的模式。 30例患者接受动脉内溴脱氧尿苷（BUdR）放射增敏与局部脑放射治疗，12例患者接受常规局部脑放射治疗。 肿瘤边缘在术前和复发CT扫描上被定义为对比增强区域;这些在醋酸模板上被追踪，并相互比较，并与实际扫描进行比较。在所有42例患者中，病灶在原始肿瘤的2 cm边缘内复发。 4例患者有两个复发区域：2例第二区域在2 cm边缘内，2例在此边缘外。 这些结果与Hochberg和Pruitt的结果相似。 提示局部放疗是目前治疗恶性星形细胞瘤的最佳方法。 由于复发继续在照射体积内，似乎更高的局部辐射剂量适合于恶性星形细胞瘤的临床治疗试验。
Hochberg and Pruitt have reported glioblastomas recurring within 2 cm of the primary site in 90% of patients after whole-brain radiation therapy. They suggested that computerized tomography (CT) scan accuracy would permit smaller radiation fields. A treatment protocol with smaller-field focal brain irradiation following surgical resection is reported. The first 4500 cGy of radiation is focused to within a 3-cm margin around the tumor, with a 1500-cGy boost within a 1.5-cm margin. Forty-two patients with grade III or IV astrocytoma, treated with focal brain radiation therapy were reviewed retrospectively to assess patterns of tumor recurrence. Thirty patients received intra-arterial bromodeoxyuridine (BUdR) radiosensitization with focal brain radiation therapy, and 12 patients underwent conventional focal brain radiation therapy. Tumor margin was defined on preoperative and recurrence CT scans as the contrast-enhanced area; these were traced on acetate templates and compared with each other and with the actual scans.In all 42 patients, the lesion recurred within a 2-cm margin of the original tumor. Four patients had two recurrent areas: the second area was within the 2-cm margin in two, and outside this margin in two. These results are similar to those of Hochberg and Pruitt. It is suggested that focal irradiation is now the optimal treatment for malignant astrocytoma. Since recurrences continue to be within the irradiated volumes, it appears that higher focal doses of radiation are appropriate for clinical treatment trials of malignant astrocytomas.