Reirradiation of recurrent high-grade glioma and development of prognostic scores for progression and survival
Reirradiation of recurrent high-grade glioma and development of prognostic scores for progression and survival
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DOI：
10.1093/nop/npz017
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发表时间：
2019-10-01
影响因子：
2.7
通讯作者：
Braunstein, Steve E.
中科院分区：
文献类型：
--
作者：
Chapman, Christopher H.;Hara, Jared H.;Braunstein, Steve E.
背景。高级别胶质瘤 (HGG) 挽救性再照射的最佳技术和患者选择尚不清楚。在这项研究中，我们确定了再照射后无进展 (FFP) 和总生存 (OS) 的预后因素、高级别毒性的危险因素，并验证了临床预后评分。方法。 2000 年至 2018 年间，共有 116 名患者接受了 HGG 再照射（99 名 WHO IV 级，17 名 WHO III 级）。初始治疗后首次进展的中位时间为 10.6 个月。再照射前的挽救治疗包括手术（31%）和全身治疗（41%）。 65 名患者 (56%) 接受单次立体定向放射外科 (SRS) 作为再照射。 SRS 治疗的中位生物有效剂量 (BED) 为 47.25 Gy，中位计划靶体积 (PTV) 为 4.8 cc，非 SRS 治疗为 95.0 cc。 52% 的患者同时接受全身治疗，74% 的患者接受辅助治疗。结果。中位 FFP 为 4.9 个月，中位 OS 为 11.0 个月。 FFP 的重要多变量预后因素是体能状态、初始进展时间和 BED；对于 OS，它们是年龄、初始进展时间和复发时 PTV 体积。高度毒性与复发时 PTV 大小相关。针对 FFP 和 OS 生成三级预后评分，交叉验证的受试者工作特征曲线下面积 (AUC) 分别为 0.640 和 0.687。结论。 HGG 再照射时的临床变量可用于预测 FFP 和 OS。
Background. Optimal techniques and patient selection for salvage reirradiation of high-grade glioma (HGG) are unclear. In this study, we identify prognostic factors for freedom from progression (FFP) and overall survival (OS) after reirradiation, risk factors for high-grade toxicity, and validate clinical prognostic scores.Methods. A total of 116 patients evaluated between 2000 and 2018 received reirradiation for HGG (99 WHO grade IV, 17 WHO grade III). Median time to first progression after initial therapy was 10.6 months. Salvage therapies before reirradiation included surgery (31%) and systemic therapy (41%). Sixty-five patients (56%) received single-fraction stereotactic radiosurgery (SRS) as reirradiation. The median biologically effective dose (BED) was 47.25 Gy, and the median planning target volume (PTV) was 4.8 cc for SRS and 95.0 cc for non-SRS treatments. Systemic therapy was given concurrently to 52% and adjuvantly to 74% of patients.Results. Median FFP was 4.9 months, and median OS was 11.0 months. Significant multivariable prognostic factors for FFP were performance status, time to initial progression, and BED; for OS they were age, time to initial progression, and PTV volume at recurrence. High-grade toxicity was correlated to PTV size at recurrence. Three-level prognostic scores were generated for FFP and OS, with cross-validated receiver operating characteristic area under the curve (AUC) of 0.640 and 0.687, respectively.Conclusions. Clinical variables at the time of reirradiation for HGG can be used to prognosticate FFP and OS.