Hypofractionated intensity-modulated radiotherapy for primary glioblastoma multiforme
Hypofractionated intensity-modulated radiotherapy for primary glioblastoma multiforme
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DOI：
10.1016/s0360-3016(03)01623-7
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发表时间：
2004-03-01
影响因子：
7
通讯作者：
Butler, EB
中科院分区：
文献类型：
--
作者：
Floyd, NS;Woo, SY;Butler, EB
目的：一项初步研究旨在评价一种新的大分割调强放疗（RT）方案辅助治疗原发性多形性胶质母细胞瘤（GBM）的安全性和有效性。该研究的基本原理是将低分割治疗GBM的潜在放射生物学优势与高度适形放射治疗技术结合联合收割机。这项研究的目的是衡量急性和慢性发病率的患者用这个方案治疗，GBM的治疗反应，总生存期，和治疗完成后的疾病进展的时间。方法和材料：20名符合条件的患者在1999年2月和2000年5月之间的研究。所有患者的Karnofsky评分均大于或等于70。所有患者均使用NOMOS Peacock系统进行调强RT治疗。剂量为50戈伊，每日5-戈伊，2周内进行强化原发病、残留肿瘤或手术腔。同时，30戈伊，3-戈伊，每天分次，周围水肿。RT完成后，通过一系列神经系统检查和MRI或CT扫描测量至进展的时间。急性和晚期毒性分级放射治疗肿瘤组神经毒性scores.Results：20例患者中，18例进行了评价的结果。至疾病进展的中位时间为RT完成后6个月。中位总生存期为治疗完成后7个月。复发病灶均位于手术床2cm以内。治疗期间的神经毒性很小，所有患者均发生0级或I级毒性。晚期毒性包括10例0级患者、2例2级患者和3例4级毒性患者，表现为需要手术再次切除的脑坏死。3例脑坏死患者的生存时间分别为23、20和9个月。在所有情况下的死亡率是肿瘤复发的结果，没有死亡率导致脑necrosis.Conclusion：这种方案的hypofractionated调强RT没有改善疾病进展的时间或总生存率与历史经验相比，使用传统的分割。然而，治疗持续时间从6周缩短至2周，这在某些患者亚组中可能具有姑息性获益。该治疗方案显示需要手术干预的脑坏死发生率更高;然而，发生该毒性的3例患者的生存时间更长。未来的研究可能是有用的，以确定哪一部分大小可能是最佳的GBM时，高度适形RT是用于辅助设置。(C)2004年爱思唯尔公司
Purpose: A pilot study was designed to evaluate the safety and efficacy of a novel regimen of hypofractionated intensity-modulated radiotherapy (RT) in the adjuvant treatment of primary glioblastoma multiforme (GBM). The rationale of the study was to combine the potential radiobiologic advantage of hypofractionation to GBM with a highly conformal radiotherapeutic technique. The study was designed to measure the acute and chronic morbidity of patients treated with this regimen, response of GBM to the treatment, overall survival, and time to disease progression after therapy completion.Methods and Materials: Twenty eligible patients were accrued between February 1999 and May 2000 for the study. All patients had Karnofsky performance scores of greater than or equal to70. All patients were treated with intensity-modulated RT using the NOMOS Peacock system. A dose of 50 Gy was delivered in 5-Gy daily fractions within 2 weeks to enhancing primary disease, residual tumor, or surgical cavity. Simultaneously, 30 Gy was prescribed in 3-Gy daily fractions to surrounding edema. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicity was graded using Radiation Therapy Oncology Group neurotoxicity scores.Results: Of the 20 patients, 18 were evaluated for outcome. The median time to disease progression was 6 months after RT completion. The median overall survival was 7 months after treatment completion. All recurrences were within 2 cm of the operative bed. Neurotoxicity during therapy was minimal, with all patients experiencing Grade 0 or I toxicity. Late toxicity included 10 patients with Grade 0, 2 patients with Grade 2, and 3 patients with Grade 4 toxicity, manifesting as brain necrosis requiring surgical reexcision. The survival of the 3 patients with brain necrosis was 23, 20, and 9 months. Mortality in all cases was the result of tumor recurrence, with no mortality resulting from brain necrosis.Conclusion: This regimen of hypofractionated intensity-modulated RT did not improve the time to disease progression or overall survival compared with historical experience using conventional fractionation. However, the treatment duration was reduced from 6 weeks to 2 weeks, which may be of palliative benefit in certain subsets of patients. This treatment regimen demonstrated a greater incidence of brain necrosis requiring surgical intervention; however, the 3 patients experiencing this toxicity had longer survival times. Future investigation may be useful to determine which fraction size may be optimal for GBM when highly conformal RT is used in the adjuvant setting. (C) 2004 Elsevier Inc.