Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy
Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy
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DOI：
10.1200/jco.20.6.1635
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发表时间：
2002-03-15
影响因子：
45.3
通讯作者：
Sandler, HM
中科院分区：
文献类型：
--
作者：
Chan, JL;Lee, SW;Sandler, HM
目的：三维 (3-D) 适形放射的目标是增加肿瘤的剂量，同时最大限度地减少周围正常大脑的剂量。此前已有研究表明，即使剂量增加到 70 至 80 Gy，也会出现主要是局部的失效模式。本文描述了使用 3-D 适形调强辐射技术给予 90 Gy 的高级别神经胶质瘤的失败模式和存活率。患者和方法。 1996年4月至1999年4月，34例幕上高级别胶质瘤患者接受了90Gy的治疗。对于那些复发的肿瘤，失败模式是根据位于高剂量区域内的复发肿瘤的百分比来定义的。超过 95% 的体积位于高剂量区域内的复发被认为是中心复发； 80%至95%、20%至80%和低于20%分别被认为是现场、边缘和远处。结果：中位年龄为55岁，中位随访时间为11.7个月。截至分析时，34 名患者中有 23 名 (67.6%) 出现复发的影像学证据。失败模式为：23 次中心故障中的 18 次（78%）、23 次现场故障中的 3 次（13%）、23 次边缘故障中的 2 次（9%）、23 次远距离故障中的零次（0%）。中位生存期为11.7个月，其中1年生存率为47.1%，2年生存率为12.9%。未观察到明显的治疗毒性。结论：尽管剂量增加至 90 Gy，但高级别神经胶质瘤的主要失败模式仍然是局部的。这表明高度适形治疗中使用的近距离切缘不会增加边缘或远处复发的风险。我们的结果表明，通过剂量递增强化局部放疗是可行的，值得对高级别胶质瘤进行进一步评估。
Purpose: The goal of three-dimensional (3-D) conformal radiation is to increase the dose delivered to tumor while minimizing dose to surrounding normal brain. Previously it has been shown that even escalated doses of 70 to 80 Gy have failure patterns that are predominantly local. This article describes the failure patterns and survival seen with high-grade gliomas given 90 Gy using a 3-D conformal intensity-modulated radiation technique.Patients and Methods. From April 1996 to April 1999, 34 patients with supratentorial high-grade gliomas were treated to 90 Gy. For those that recurred, failure patterns were defined in terms of percentage of recurrent tumor located within the high-dose region. Recurrences with more than 95% of their volume within the high-dose region were considered central; those with 80% to 95%, 20% to 80%, and less than 20% were considered in-field, marginal, and distant, respectively.Results: The median age was 55 years, and median follow-up was 11.7 months. At time of analysis, 23 (67.6%) of 34 patients had developed radiographic evidence of recurrence. The patterns of failure were 18 (78%) of 23 central, three (13%) of 23 in-field, two (9%) of 23 marginal, and zero (0%) of 23 distant. The median survival was 11.7 months, with 1-year survival of 47.1% and 2-year survival of 12.9%. No significant treatment toxicities were observed.Conclusion: Despite dose escalation to 90 Gy, the predominant failure pattern in high-grade gliomas remains local. This suggests that close margins used in highly conformal treatments do not increase the risk of marginal or distant recurrences. Our results indicate that intensification of local radiotherapy with dose escalation is feasible and deserves further evaluation for high-grade gliomas.