Treatment of recurrent glioblastoma with stereotactic radiotherapy: long-term results of a mono-institutional trial
Treatment of recurrent glioblastoma with stereotactic radiotherapy: long-term results of a mono-institutional trial
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DOI：
10.1177/030089161109700111
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发表时间：
2011-01-01
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影响因子：
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通讯作者：
Giorgi, Cesare
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文献类型：
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作者：
Maranzano, Ernesto;Anselmo, Paola;Giorgi, Cesare
目标和背景。关于正常脑组织对再照射的耐受性的临床数据很少。本研究评价了22例复发性胶质母细胞瘤患者接受放射外科或分次立体定向放射治疗后的长期疗效。22例患者接受放射外科治疗（13，59%）或分次立体定向放射治疗（9，41%）治疗复发性胶质母细胞瘤的24个病灶。男性/女性比例为14：8，中位年龄为55岁（范围：27 - 81），中位Karnofsky体能状态为90（范围：70 - 100）。大多数病例（77%）属于递归分区分析III或IV类。根据病灶大小和部位选择放射外科或分次立体定向放射治疗。初次放疗和再次放疗之间的中位时间为9个月。放射外科和分割立体定向放射治疗的中位剂量分别为17戈伊和30戈伊，而中位累积归一化总剂量分别为141戈伊和98戈伊。所有接受放射外科治疗的患者的累积标准化总剂量均超过100戈伊，而只有少数（44%）分次立体定向放射治疗患者的累积标准化总剂量超过100戈伊。再次照射后的中位随访时间为54个月。在分析时，所有患者均已死亡。再次照射后，1个（4%）病灶部分缓解，16个（67%）病灶稳定，其余7个（29%）病灶进展。中位反应持续时间为6个月，中位生存期为11个月。13例接受放射外科治疗的患者中有3例（23%）发生了无症状的脑放射性坏死。3例患者的累积标准化总剂量分别为122戈伊、124戈伊和141戈伊。1例病灶体积较大（14 cc），另2例第1、2周期放疗间隔时间较短（5个月）。放射外科和立体定向放射治疗对复发胶质母细胞瘤患者的再照射是可行和有效的。除了准确选择患者的重要性外，还必须考虑累积放射治疗剂量和放射外科或分次立体定向放射治疗的正确适应症，以避免脑毒性。可在www.example.com上获得免费全文
Aims and background. Few clinical data exist concerning normal brain tissue tolerance to re-irradiation. The present study evaluated long-term outcome of 22 recurrent glioblastoma patients re-irradiated with radiosurgery or fractionated stereotactic radiotherapy.Methods. Twenty-two patients were treated with radiosurgery (13, 59%) or fractionated stereotactic radiotherapy (9, 41%) for 24 lesions of recurrent glioblastoma. The male/female ratio was 14:8, median age 55 years (range, 27-81), and median Karnofsky performance status 90 (range, 70-100). The majority of the cases (77%) was in recursive partitioning analysis classes III or IV. Radiosurgery or fractionated stereotactic radiotherapy was chosen according to lesion size and location.Results. Median time between primary radiotherapy and re-irradiation was 9 months. Median doses were 17 Gy and 30 Gy, whereas median cumulative normalized total dose was 141 Gy and 98 Gy for radiosurgery and fractionated stereotactic radiotherapy, respectively. All patients submitted to radiosurgery had a cumulative normalized total dose of more than 100 Gy, whereas only a few (44%) of fractionated stereotactic radiotherapy patients had a cumulative normalized total dose exceeding 100 Gy. Median follow-up from re-irradiation was 54 months. At the time of analysis, all patients had died. After re-irradiation, 1 (4%) lesion was in partial remission, 16 (67%) lesions were stable, and the remaining 7 (29%) were in progression. Median duration of response was 6 months, and median survival from re-irradiation 11 months. Three of 13 (23%) patients submitted to radiosurgery developed asymptomatic brain radionecrosis. The cumulative normalized total dose for the 3 patients was 122 Gy, 124 Gy, and 141 Gy, respectively. In one case, the volume of the lesion was large (14 cc), and in the other 2 the interval between the first and second cycle of radiotherapy was short (5 months).Conclusions. Re-irradiation with radiosurgery and fractionated stereotactic radiotherapy is feasible and effective in recurrent glioblastoma patients. Apart from the importance of an accurate patient selection, cumulative radiotherapy dose and a correct indication for radiosurgery or fractionated stereotactic radiotherapy must be taken into account to avoid brain toxicity. Free full text available at www.tumorionline.it