Prognostic factors in glioblastoma multiforme patients receiving high-dose particle radiotherapy or conventional radiotherapy
Prognostic factors in glioblastoma multiforme patients receiving high-dose particle radiotherapy or conventional radiotherapy
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DOI：
10.1259/bjr/29022270
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发表时间：
2011-12-01
影响因子：
2.6
通讯作者：
Matsumura, A.
中科院分区：
文献类型：
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作者：
Matsuda, M.;Yamamoto, T.;Matsumura, A.
本研究的目的是评估与患者选择相关的预后因素对生存结果的影响。对67例新诊断的多形性胶质母细胞瘤(GBM)患者接受常规分割光子放射治疗(CRT)或大剂量粒子放射治疗(HDT)后的生存结果进行了回顾性分析。CRT方案总剂量为60.0~61.2Gy.在HDT方案中，接受硼中子俘获治疗的患者接受平均单次约30GYe的剂量和总剂量为30Gy的额外分次光子照射；接受质子治疗的患者接受总剂量96.6GYe。大多数患者接受了盐酸尼莫司汀(ACNU)单独或联合ACNU、普鲁卡巴津和长春新碱的化疗。中位总生存期和无进展生存期分别为17.7个月[95%可信区间14.6~20.9个月]和7.8个月(95%可信区间5.7~9.9个月)。1、2年生存率分别为67.2%和33.7%。接受HDT治疗的患者的中位OS为24.4个月(95%CI，18.2~30.5个月)，而接受CRT治疗的患者中位OS为14.2个月(95%CI，10.0~18.3个月)。COX比例风险模型显示放射治疗方式(HDT与CRT)和欧洲癌症研究与治疗组织递归分区分析类别是重要的预后因素。年龄、性别、术前表现状况、接受或不接受高级神经影像检查、手术范围和化疗方案对预后的预测无统计学意义。65岁及以上患者的中位OS为18.5个月(95%CI，9.9~27.1月)，而以下患者的中位OS为16.8个月(95%CI，13.6~20.1月)(p=0.871)。HDT治疗的积极效果不太可能仅反映患者的选择。需要严格控制纳入标准的随机试验，以确保患者的选择具有可比性，以最终证明延长生存期可归因于高剂量粒子放射疗法。
The aim of this study was to evaluate the influence of prognostic factors related to patient selection on survival outcomes. Survival outcomes were retrospectively analysed in a consecutive series of 67 newly diagnosed glioblastoma multiforme (GBM) patients who had received either conventional fractionated photon radiotherapy (CRT) or high-dose particle radiotherapy (HDT). In the CRT protocol, a total dose of 60.0-61.2 Gy was administered. In the HDT protocol, an average dose of approximately 30 GyE in a single session and additional fractionated photon irradiation of total dose 30 Gy were administered to patients receiving boron neutron capture therapy; and a total dose of 96.6 GyE was administered to patients receiving proton therapy. Most of the patients had received chemotherapy with nimustine hydrochloride (ACNU) alone or with ACNU, procarbazine and vincristine. The median overall survival (OS) and progression-free survival times for all patients were 17.7 months [95% confidence interval (CI), 14.6-20.9 months] and 7.8 months (95% CI, 5.7-9.9 months), respectively. The 1- and 2-year survival rates were 67.2% and 33.7%, respectively. For patients treated with HDT, the median OS was 24.4 months (95% CI, 18.2-30.5 months), compared with 14.2 months (95% CI, 10.0-18.3 months) for those treated with CRT. The Cox proportional hazards model revealed radiation modality (HDT vs CRT) and European Organisation for Research and Treatment of Cancer recursive partitioning analysis class to be the significant prognostic factors. Age, sex, pre-operative performance status, treatment with or without advanced neuroimaging, extent of surgery and regimen of chemotherapy were not statistically significant factors in predicting prognosis. The median OS was 18.5 months (95% CI, 9.9-27.1 months) in patients of 65 years and older, compared with 16.8 months (95% CI, 13.6-20.1 months) in those 64 years and younger (p = 0.871). The positive effect of HDT treatment is unlikely to reflect patient selection alone. Randomised trials with strictly controlled inclusion criteria to ensure the comparable selection of patients are required to demonstrate conclusively that prolonged survival can be attributed to high-dose particle radiotherapies.