Patterns of failure for glioblastoma multiforme following concurrent radiation and temozolomide
Patterns of failure for glioblastoma multiforme following concurrent radiation and temozolomide
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DOI：
10.1111/j.1754-9485.2010.02232.x
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发表时间：
2011-02-01
影响因子：
1.6
通讯作者：
Fiveash, John B.
中科院分区：
文献类型：
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作者：
Dobelbower, Michael C.;Burnett, Omer L., III;Fiveash, John B.
目的：分析失败的多形性胶质母细胞瘤患者同时放疗和替莫唑胺治疗的模式。材料和方法：回顾性分析患者同时放疗和替莫唑胺治疗。在伯明翰的亚拉巴马大学接受治疗的20名患者，活检证实患有疾病，治疗后记录了疾病进展，并有足够的辐射剂量测定和成像记录。患者通常接受46戈伊至原发肿瘤和周围水肿加1 cm，60戈伊至增强肿瘤加1 cm。记录治疗后失败的MRI与原始治疗计划融合。治疗后肿瘤体积的轮廓由显示肿瘤衰竭的MRI生成，并覆盖在原始等剂量曲线上。复发性肿瘤被分类为在外地，边缘或区域。复发也进行了评估远端failure.Results：20个记录失败，所有患者都有一些组件的失败在主要网站。18名患者（90%）在现场失败，2名患者（10%）有边缘失败，没有发生区域失败。四名患者（20%）有一个组件的远端失败，其中一个独立的卫星病变位于完全以外的95%的等剂量curvet.Conclusions：放射治疗同时与替莫唑胺似乎与一个中度风险的远端脑功能衰竭除了局部失败率高。远端脑功能衰竭的风险与单纯放疗的风险一致，表明替莫唑胺不能减少远端脑功能衰竭，但能改善局部控制。
Purpose:To analyse patterns of failure in patients with glioblastoma multiforme treated with concurrent radiation and temozolomide.Materials and Methods:A retrospective review of patients treated with concurrent radiation and temozolomide was performed. Twenty patients treated at the University of Alabama at Birmingham, with biopsy-proven disease, documented disease progression after treatment, and adequate radiation dosimetry and imaging records were included in the study. Patients generally received 46 Gy to the primary tumour and surrounding oedema plus 1 cm, and 60 Gy to the enhancing tumour plus 1 cm. MRIs documenting failure after therapy were fused to the original treatment plans. Contours of post-treatment tumour volumes were generated from MRIs showing tumour failure and were overlaid onto the original isodose curves. The recurrent tumours were classified as in-field, marginal or regional. Recurrences were also evaluated for distant failure.Results:Of the 20 documented failures, all patients had some component of failure at the primary site. Eighteen patients (90%) failed in-field, 2 patients (10%) had marginal failures, and no regional failures occurred. Four patients (20%) had a component of distant failure in which an independent satellite lesion was located completely outside of the 95% isodose curve.Conclusions:Radiation concurrent with temozolomide appears to be associated with a moderate risk of distant brain failure in addition to the high rate of local failure. The risk of distant failure was consistent with that observed with radiation alone, suggesting that temozolomide does not act to reduce distant brain failure but to improve local control.