Current status and recent advances in reirradiation of glioblastoma.

Current status and recent advances in reirradiation of glioblastoma.
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DOI:
10.1186/s13014-021-01767-9
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发表时间:
2021-02-18
期刊:
Radiation oncology (London, England)
影响因子:
--
通讯作者:
Belka C
Belka C
中科院分区:
其他
文献类型:
--
作者:
Minniti G;Niyazi M;Alongi F;Navarria P;Belka C

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尽管采取了积极的治疗措施,包括最大程度的安全手术切除,然后进行外照射放射治疗(60 Gy/30 次)并同时辅助替莫唑胺,但大约 90% 的 WHO IV 级神经胶质瘤(胶质母细胞瘤,GBM)将在 2 年内局部复发。对于复发性 GBM 患者,不存在护理标准。随着放射科学技术的不断进步,再放射治疗已成为脑肿瘤患者可行的治疗方法。一些研究表明,使用立体定向放射外科 (SRS) 或立体定向放射治疗 (SRT),无论是大分割还是传统分割方案,复发性 GBM 患者在再放疗后可提高生存率;然而,关于第二疗程放射治疗的疗效和毒性仍有待解答。我们提供了 GBM 再照射的现状和最新进展的临床概述,解决了相关的临床问题,例如适当的患者选择和放射技术、最佳剂量分割、大脑的再照射耐受性和放射性坏死的风险。
Despite aggressive management consisting of maximal safe surgical resection followed by external beam radiation therapy (60 Gy/30 fractions) with concomitant and adjuvant temozolomide, approximately 90% of WHO grade IV gliomas (glioblastomas, GBM) will recur locally within 2 years. For patients with recurrent GBM, no standard of care exists. Thanks to the continuous improvement in radiation science and technology, reirradiation has emerged as feasible approach for patients with brain tumors. Using stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT), either hypofractionated or conventionally fractionated schedules, several studies have suggested survival benefits following reirradiation of patients with recurrent GBM; however, there are still questions to be answered about the efficacy and toxicity associated with a second course of radiation. We provide a clinical overview on current status and recent advances in reirradiation of GBM, addressing relevant clinical questions such as the appropriate patient selection and radiation technique, optimal dose fractionation, reirradiation tolerance of the brain and the risk of radiation necrosis.
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