A MEDICAL-RESEARCH-COUNCIL TRIAL OF 2 RADIOTHERAPY DOSES IN THE TREATMENT OF GRADE-3 AND GRADE-4 ASTROCYTOMA
A MEDICAL-RESEARCH-COUNCIL TRIAL OF 2 RADIOTHERAPY DOSES IN THE TREATMENT OF GRADE-3 AND GRADE-4 ASTROCYTOMA
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DOI：
10.1038/bjc.1991.396
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发表时间：
1991-10-01
影响因子：
8.8
通讯作者：
STENNING, SP
中科院分区：
文献类型：
--
作者：
BLEEHEN, NM;STENNING, SP
共有474例3级或4级恶性胶质瘤（星形细胞瘤）成人患者被随机分配到MRC研究（BR 2）中，比较术后给予的45戈伊（4周内20次）和60戈伊（6周内30次）放疗。 采用2：1随机分配，318例患者分配60戈伊疗程，156例患者分配45戈伊疗程。 未给予辅助化疗。 结果表明，60戈伊的疗程可适度延长无进展生存期和总生存期。 结果表明，中位生存期从45戈伊组的9个月延长到60戈伊组的12个月，具有统计学意义（危险比= 0.75，卡方2 = 7.36，d.f. = 1，P = 0.007）。 超过80%的患者报告放疗未导致发病，并且没有证据表明高剂量组的短期发病率增加。 未评估晚期发病率。 在先前MRC研究中定义的预后指数在这个新队列中得到验证。 它确定了一组患者（占总数的20%），2年生存率为28%（95%置信区间为19%至38%）。 很明显，即使在该指数定义的最差预后组中，也保持了较高剂量的生存优势。
A total of 474 adult patients with malignant glioma (astrocytoma) grade 3 or 4 were randomised into an MRC study (BR2) comparing 45 Gy (in 20 fractions over 4 weeks) with 60 Gy (in 30 fractions over 6 weeks) of radiotherapy given post-operatively. Using 2:1 randomisation, 318 patients were allocated the 60 Gy course and 156 the 45 Gy course. Adjuvant chemotherapy was not given. The results show that a 60 Gy course produces a modest lengthening of progression-free and overall survival. They suggest a statistically significant prolongation of median survival from 9 months in the 45 Gy group to 12 months in the 60 Gy group (hazard ratio = 0.75, chi-2 = 7.36, d.f. = 1, P = 0.007). Over 80% of patients reported no morbidity from the radiotherapy, and there was no evidence of increased short-term morbidity in the higher dose group. Late morbidity was not assessed. A prognostic index defined in a previous MRC study was validated in this new cohort. It identifies a group of patients (20% of the total) with a 2 year survival rate of 28% (95% confidence interval 19% to 38%). It was apparent that the survival advantage to the higher dose was maintained even in the poorest prognostic groups defined by this index.