Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival
Salvage reirradiation for recurrent glioblastoma with radiosurgery: radiographic response and improved survival
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DOI：
10.1007/s11060-008-9752-9
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发表时间：
2009-04-01
影响因子：
3.9
通讯作者：
Ryu, Samuel
中科院分区：
文献类型：
--
作者：
Patel, Mehul;Siddiqui, Farzan;Ryu, Samuel
目的探讨立体定向单剂量放射外科（SRS）和分次立体定向放射治疗（FSRT）作为胶质母细胞瘤（GBM）复发挽救治疗的影像学和临床疗效。方法2001年3月至2006年8月，对36例经病理证实的复发性GBM患者进行SRS或FSRT挽救性再照射治疗。31例患者初步诊断为GBM。5例患者发生恶性转化。所有患者均接受了剂量为50-60戈伊的放疗，再次放疗前中位时间为13.6个月（范围：0.8-119个月）。复发时，26例患者接受SRS治疗，中位剂量为18戈伊（范围：12-20戈伊）。10例患者接受FSRT，剂量为36戈伊，分6次，每周2次。随访包括MRI和临床检查，每2个月。结果SRS后中位生存时间为8.5个月，FSRT后为7.4个月（P = 0.81）。在接受SRS治疗的26例患者中，在8例（35%）患者中观察到放射学肿瘤缓解或疾病稳定，在18例（65%）患者中观察到肿瘤进展。在接受FSRT治疗的10例患者中，在4例（40%）患者中观察到放射学肿瘤缓解或疾病稳定，在4例（40%）患者中观察到肿瘤进展（2例失访）。与无应答者相比，对治疗有应答的患者的生存率有统计学改善，中位生存期为15.8个月对7.3个月（P < 0.05）。结论SRS或FSRT补救性再照射治疗复发性GBM可使部分患者产生放射学反应。与无反应者相比，挽救再照射后有反应或病情稳定的患者的生存率显着提高。复发性胶质母细胞瘤再照射的方法和时机有待进一步研究。
Purpose To determine the radiographic and clinical efficacy of stereotactic single dose radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) as salvage therapy for glioblastoma (GBM) at recurrence. Methods Thirty-six patients with pathologically proven recurrent GBM were treated with salvage reirradiation by either SRS or FSRT between March of 2001 and August of 2006. Thirty-one patients had an initial diagnosis of GBM. Five patients had a malignant transformation. All patients had received radiotherapy with a dose of 50-60 Gy, a median 13.6 months prior to reirradiation (range: 0.8-119 months). At the time of recurrence, 26 patients were treated with SRS with a median dose of 18 Gy (range: 12-20 Gy). FSRT was performed in ten patients with a dose of 36 Gy in six fractions, twice weekly. Follow-up included MRI and clinical examination every 2 months. Results Median survival time after SRS was 8.5 months, compared to 7.4 months after FSRT (P = 0.81). Of 26 patients treated with SRS, radiographic tumor response or stable disease was observed in eight (35%) patients and tumor progression was seen in 18 (65%) patients. Of 10 patients treated by FSRT, radiographic tumor response or stable disease was observed in four (40%) patients and tumor progression was observed in four (40%) patients (two lost to follow-up). Patients who responded to treatment had statistically improved survival compared to non-responders, with median survival of 15.8 vs. 7.3 months (P < 0.05). Conclusion Salvage reirradiation with SRS or FSRT for recurrent GBM results in radiographic response in a proportion of patients. Survival was significantly improved among patients who either responded or had stable disease after salvage reirradiation, compared to non-responders. Further study is warranted to investigate the method and time of reirradiation for recurrent GBM.