GliaSite brachytherapy for treatment of recurrent malignant gliomas: A retrospective multi-institutional analysis
GliaSite brachytherapy for treatment of recurrent malignant gliomas: A retrospective multi-institutional analysis
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DOI：
10.1227/01.neu.0000194836.07848.69
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发表时间：
2006-04-01
期刊：
影响因子：
4.8
通讯作者：
Stea, B
中科院分区：
文献类型：
--
作者：
Gabayan, AJ;Green, SB;Stea, B
目的：回顾 10 家机构使用近距离放射治疗装置 GliaSite 放射治疗系统治疗复发性恶性胶质瘤的累积经验。 方法：患者群体包括 95 例复发性 3 级或 4 级胶质瘤患者，中位年龄 51 岁，中位卡诺夫斯基体能状态评分 80 分。 他们的初步治疗。复发后，每位患者均接受了最大程度的手术切除复发病灶，并在肿瘤腔内放置可扩张球囊导管 (GliaSite)。球囊后加载液体 (125)l (lotrex)，以 52.3 Gy/hr 的中值剂量率将 60 Gy 的中值剂量递送至 1 cm 的平均深度。通过连续磁共振成像对患者进行仔细随访，并每月检查肿瘤进展、副作用和生存情况。结果：从 GIiaSite 植入之日起计算，所有患者的中位生存期为 36.3 周，估计 1 年生存率为 31.1%。初次诊断为多形性胶质母细胞瘤的患者的中位生存期为 35.9 周，非多形性胶质母细胞瘤恶性胶质瘤患者的中位生存期为 43.6 周。对各种个体预后因素对患者生存的影响的分析表明，只有卡诺夫斯基表现状态才能显着预测生存的改善。有 3 例病理记录的放射性坏死病例。 结论：再切除后使用 GIiaSite 放射治疗系统对恶性神经胶质瘤进行再照射似乎比单独手术的预期提供了适度的生存获益。该报告不仅证实了可行性研究的初步结果，而且提供了证据表明在临床试验之外也可以获得类似的结果。
OBJECTIVE: To review the cumulative experience of 10 institutions in treating recurrent malignant gliomas with the brachytherapy device, GliaSite Radiation Therapy System.METHODS: The patient population consisted of 95 patients with recurrent grade 3 or 4 gliomas, a median age of 51 years, and a median Karnofsky performance status score of 80. All patients had previously undergone resection and had received external beam radiotherapy as part of their initial treatment. After recurrence, each patient underwent maximal surgical debulking of their recurrent lesion and placement of an expandable balloon catheter (GliaSite) in the tumor cavity. The balloon was afterloaded with liquid (125)l (lotrex) to deliver a median dose of 60 Gy to an average depth of 1 cm with a median dose rate of 52.3 Gy/hr. Patients were carefully followed with serial magnetic resonance imaging and monthly examinations for tumor progression, side effects, and survival.RESULTS: The median survival for all patients, measured from date of GIiaSite placement, was 36.3 weeks with an estimated 1 year survival of 31.1 %. The median survival was 35.9 weeks for patients with an initial diagnosis of glioblastoma multiforme and 43.6 weeks for those with non-glioblastoma multiforme malignant gliomas. Analysis of the influence of various individual prognostic factors on patient survival demonstrated that only Karnofsky performance status significantly predicted for improved survival. There were three cases of pathologically documented radiation necrosis.CONCLUSION: Reirradiation of malignant gliomas with the GIiaSite Radiation Therapy System after reresection seems to provide a modest survival benefit above what would be expected from Surgery alone. This report not only confirms the initial results of the feasibility study but provides evidence that similar outcomes can be obtained outside of a clinical trial.