Intensity-modulated radiation therapy in childhood ependymoma
Intensity-modulated radiation therapy in childhood ependymoma
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DOI：
10.1016/j.ijrobp.2007.11.058
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发表时间：
2008-07-15
影响因子：
7
通讯作者：
Paulino, Arnold C.
中科院分区：
文献类型：
--
作者：
Schroeder, Thomas M.;Chintagumpala, Murali;Paulino, Arnold C.
目的：探讨调强放射治疗(IMRT)治疗局限性脑室管膜瘤的失败模式。方法与材料：1994年至2005年，22例经手术病理证实的儿童局限性脑室管膜瘤采用调强放射治疗。在这些患者中，12例(55%)有幕下肿瘤，14例(%)有间变性组织学。5例患者接受了次全切除(STR)，这是术后磁共振成像所证实的。临床靶区包括肿瘤床和任何残留病变加切缘(中位剂量54GY)。存活患者的中位随访期为39.8个月。结果：3年总生存率为87%+/-9%。3年局控率为68%+/-12%。有6次局部复发，均发生在治疗野的高剂量区域。中位复发时间为21.7个月。5例STR患者中，4例复发，3例死亡。大体全切除患者的局部控制率(p=0.024)和总存活率(p=0.008)明显好于短暂性全切除患者。在最后一次随访中，没有患者出现视力丧失、脑坏死、脊髓炎或第二次恶性肿瘤。结论：调强放射治疗的局部控制率和存活率与历史文献中使用大剂量治疗的患者相当。所有的失败都在高剂量范围内，这表明调强放疗并不会削弱局部控制。手术切除的程度对局部控制和生存有重要意义。(C)2008年爱思唯尔公司。
Purpose: To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma.Methods and Materials: From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months.Results: The 3-year overall survival rate was 87% +/- 9%. The 3-year local control rate was 68% +/- 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy.Conclusions: Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival. (C) 2008 Elsevier Inc.