RADIATION NECROSIS OR GLIOMA RECURRENCE - IS COMPUTER-ASSISTED STEREOTAXIC BIOPSY USEFUL
RADIATION NECROSIS OR GLIOMA RECURRENCE - IS COMPUTER-ASSISTED STEREOTAXIC BIOPSY USEFUL
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DOI：
10.3171/jns.1995.82.3.0436
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发表时间：
1995-03-01
影响因子：
4.1
通讯作者：
ATKINSON, EJ
中科院分区：
文献类型：
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作者：
FORSYTH, PA;KELLY, PJ;ATKINSON, EJ
51例幕上胶质瘤患者接受外照射放射治疗（中位剂量59.5戈伊），然后表现出疾病进展的临床或影像学证据，进行立体定向活检，以区分肿瘤复发和放射性坏死。原始肿瘤组织学类型为弥漫性或星形细胞瘤21例（41%），少突胶质细胞瘤13例（26%），少突星形细胞瘤17例（33%）; 40例（78%）为低级别（Kernohan 1级或2级）。至疑似疾病进展的中位时间为28个月。立体定向活检显示30名患者（59%）出现肿瘤复发，3名患者（6%）出现放射性坏死，17名患者（33%）出现两者混合; 1名患者（2%）出现实质放射诱导的成软骨细胞骨肉瘤。立体定向活检的肿瘤类型与原始肿瘤类型相似，24例患者（47%）为星形细胞瘤，8例患者（16%）为少突胶质细胞瘤，16例患者（31%）为少突星形细胞瘤，2例患者（4%）无法分类，1例患者（2%）为软骨母细胞性骨肉瘤。然而，在活检时，只有19个肿瘤（37%）是低级别的（Kernohan 1级或2级）。随后的手术证实了8例患者的立体定向活检组织学结果。随访检查显示14例患者存活，整个组的中位生存期为1年。活检后肿瘤复发患者的中位生存时间为0.83年，肿瘤复发和放射性坏死患者的中位生存时间为1.86年;这些结果有显著差异（p = 0.008，对数秩检验）。无单纯放射性坏死患者死亡。与生存率降低相关的其他因素是高比例的残留肿瘤（p = 0.024），低比例的放射性坏死（p < 0.001），以及Kernohan分级为3或4级（p = 0.005）。总之，在既往接受过放射治疗的幕上胶质瘤患者中，临床或影像学怀疑放射性坏死或肿瘤复发，立体定向活检的结果可用于区分肿瘤复发，放射性坏死，两种病变的混合物，或放射诱导的肿瘤。此外，活检结果可以预测生存率。
Fifty-one patients with supratentorial glioma treated with external beam radiotherapy (median dose 59.5 Gy) who then demonstrated clinical or radiographic evidence of disease progression underwent stereotactic biopsy to differentiate tumor recurrence from radiation necrosis. The original tumor histological type was diffuse or fibrillary astrocytoma in 21 patients (41%), oligodendroglioma in 13 (26%), and oligoastrocytoma in 17 (33%); 40 tumors (78%) were low-grade (Kernohan Grade 1 or 2). The median time to suspected disease progression was 28 months. Stereotactic biopsy showed tumor recurrence in 30 patients (59%), radiation necrosis in three (6%), and a mixture of both in 17 (33%); one patient (2%) had a parenchymal radiation-induced chondroblastic osteosarcoma. The tumor type at stereotactic biopsy was similar to the original tumor type and was astrocytoma in 24 patients (47%), oligodendroglioma in eight (16%), oligoastrocytoma in 16 (31%), unclassifiable in two (4%), and chondroblastic osteosarcoma in one patient (2%). At biopsy, however, only 19 tumors (37%) were low grade (Kernohan Grade 1 or 2). Subsequent surgery confirmed the stereotactic biopsy histological findings in eight patients. Follow-up examination showed 14 patients alive with a median survival of 1 year for the entire group. Median survival times after biopsy were 0.83 year for patients with tumor recurrence and 1.86 years for patients with both tumor recurrence and radionecrosis; these findings were significantly different (p = 0.008, log-rank test). No patient with radiation necrosis alone died. Other factors associated with reduced survival were a high proportion of residual tumor (p = 0.024), a low proportion of radionecrosis (p < 0.001), and a Kernohan Grade of 3 or 4 (p = 0.005). In conclusion, in patients with previously irradiated supratentorial gliomas in whom radionecrosis or tumor recurrence was clinically or radiographically suspected, results of stereotactic biopsy could be used to differentiate tumor recurrence, radiation necrosis, a mixture of both lesions, or radiation-induced neoplasm. In addition, biopsy results could predict survival rates.