Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study.
Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study.
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小儿家心室内手术后的保形放射疗法：一项前瞻性研究。
DOI：
10.1016/s1470-2045(08)70342-5
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发表时间：
2009-03
期刊：
影响因子：
51.1
通讯作者：
Sanford, Robert A.
中科院分区：
文献类型：
--
作者：
Merchant, Thomas E.;Li, Chenghong;Xiong, Xiaoping;Kun, Larry E.;Boop, Frederic A.;Sanford, Robert A.
室管膜瘤的成功治疗包括积极的手术干预和使用将副作用风险降至最低的方法进行放射治疗。我们将这种治疗方法扩展到3岁以下的儿童。1997年7月至2007年，153名儿童局限性室管膜瘤患者(中位年龄2.9岁，范围0.9-22.9岁)在明确手术后接受适形放射治疗。术后残存肿瘤和/或肿瘤床周围10 mm的临床靶区边缘分别给予59.4(n=131)或54.0(n=22)的剂量。间变性室管膜瘤85例，幕下肿瘤122例，既往化疗35例，切除范围(大体全切除125例，近全切除17例，次全切除11例)。对随访10年的患者记录疾病控制、失败模式和并发症。平均随访5.3年(0.4~10.4年)，死亡23例，进展36例，其中局部失败14例，远处失败15例，合并失败7例。肿瘤分级预测总体(OS)和无事件(EFS)生存和远处衰竭。切除范围可预测OS、EFS和局部失败。种族预测的操作系统。7年局部控制率为83·7%(95%CI：73·9~93·5%)，无事件生存率69·1%(95%CI：56·9~81·3%)，总生存率81·0%(95%CI：71·0~91·0%)。局部失败和远距离失败的累积发生率分别为16.3%(95%CI：9.6~23.0%)和11.48%(95%CI：5.9~17.1%)。仅考虑术后即刻行CRT治疗(无延迟或化疗)的患者，7年内局部失败的OS、EFS和CI分别为85.0%(95%CI：74·2~95·8%)、76·9%(95%CI：63·4~90·4%)、12·59%(95%CI：5.1~20·1%)和8·56%(95%CI：2.8~14.3%)。7年后继发恶性脑肿瘤的发生率为2.3%(95%可信区间：0~5.6%)，脑干坏死发生率为1.6%(95%可信区间：0~4.0%)。这项研究为室管膜瘤的治疗提供了新的疾病控制基准和统一的方法，包括手术，目的是大体全切除和术后适形、高剂量的放射治疗，即使是最小的儿童也是如此。未来的试验可能会考虑基于性别和年龄的治疗分层，因为女性患者更有可能成为长期幸存者，而年轻患者的失败率更高。
Successful therapy for ependymoma includes aggressive surgical intervention and radiation therapy administered using methods which minimize the risk of side effects. We extended this treatment approach to include children under the age of 3 years. Between July 1997 and 2007, 153 pediatric patients (median age 2·9 years, range 0·9–22·9 years) with localized ependymoma received conformal radiation therapy after definitive surgery. Doses of 59·4 (n=131) or 54·0 Gy (n=22) were prescribed to a 10mm clinical target volume margin surrounding the post-operative residual tumor and/or tumor bed. The patients had the following characteristics: anaplastic ependymoma (n=85), infratentorial location (n=122), prior chemotherapy (n=35) and extent of resection (gross-total=125, near-total=17, subtotal=11). Disease control, patterns of failure and complications were recorded for patients followed through 10 years. With a median follow-up of 5·3 years (range 0·4 to 10·4 years), death was recorded in 23 patients and tumor progression in 36, including local (n=14), distant (n=15) and combined failure (n=7). Tumor grade predicted overall (OS) and event-free (EFS) survival and distant failure. Extent of resection predicted OS, EFS and local failure. Race predicted OS. The 7 year local control, event-free and overall survival were 83·7% (95% CI: 73·9–93·5%), 69·1% (95% CI: 56·9–81·3%) and 81·0% (95% CI: 71·0–91·0%), respectively. The cumulative incidence of local and distance failure were 16·3% (95% CI: 9·6–23·0%) and 11·48% (95% CI: 5·9–17·1%), respectively. Considering only those patients treated with immediate post-operative CRT (without delay or chemotherapy) the 7 year OS, EFS and CI of local and distant failure were 85·0% (95% CI: 74·2–95·8%), 76·9% (95% CI: 63·4–90·4%), 12·59% (95% CI: 5·1–20·1%)and 8·56% (95% CI: 2·8–14·3%), respectively. The incidence of secondary malignant brain tumor at 7 years was 2·3% (95% CI: 0–5·6%) and brainstem necrosis 1·6% (95% CI: 0–4·0%). This study provides new disease control benchmarks and a unifying approach for the treatment of ependymoma that should include surgery with the aim of gross-total resection and conformal, high-dose, post-operative irradiation even for the youngest children. Future trials might consider treatment stratification based on gender and age as female patients are more likely to be long-term survivors and younger patients have higher rates of failure.
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影响因子：
8.8
作者：
Peto, R;Pike, M C;Armitage, P;Breslow, N E;Cox, D R;Howard, S V;Mantel, N;McPherson, K;Peto, J;Smith, P G
通讯作者：
Smith, P G
影响因子：
45.3
作者：
Grill, J;Le Deley, MC;Kalifa, C
通讯作者：
Kalifa, C
DOI：
10.1016/j.ijrobp.2007.11.058
发表时间：
2008-07-15
影响因子：
7
作者：
Schroeder, Thomas M.;Chintagumpala, Murali;Paulino, Arnold C.
通讯作者：
Paulino, Arnold C.
影响因子：
8.8
作者：
Peto R;Pike MC;Armitage P;Breslow NE;Cox DR;Howard SV;Mantel N;McPherson K;Peto J;Smith PG
通讯作者：
Smith PG
影响因子：
4.8
作者：
POLLACK, IF;GERSZTEN, PC;DEUTSCH, M
通讯作者：
DEUTSCH, M