Generation and validation of a prognostic score to predict outcome after re-irradiation of recurrent glioma
Generation and validation of a prognostic score to predict outcome after re-irradiation of recurrent glioma
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DOI：
10.3109/0284186x.2012.692882
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发表时间：
2013-01-01
期刊：
影响因子：
3.1
通讯作者：
Debus, Juergen
中科院分区：
文献类型：
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作者：
Combs, Stephanie E.;Edler, Lutz;Debus, Juergen
使用高精度放射技术进行再照射已成为复发性神经胶质瘤患者的临床常规。在目前的工作中，我们开发了一个实用的预后评分来预测再照射后的生存结果。患者和方法。 233 名患者接受了分割立体定向放射治疗 (FSRT)。主要组织学包括胶质母细胞瘤（n = 89；38%）、WHO III 级胶质瘤（n = 52；22%）和低级别胶质瘤（n = 92；40%）。 FSRT 的中位剂量为 36 Gy，单次 2 Gy。我们评估了再照射后的生存率以及再照射后的无进展生存率；分析的预后因素包括年龄、再照射时的肿瘤体积、组织学、初始放疗和再照射之间的时间、年龄和卡诺夫斯基评分。结果。 FSRT 后，胶质母细胞瘤的中位生存期为 8 个月，间变性胶质瘤为 20 个月，复发性低级别患者为 24 个月。显着影响再照射后生存的最强预后因素是诊断时的组织学（p < 0.0001）和年龄（= 50，p < 0.0001）以及初始放疗和再照射之间的时间 12 个月（p < 0.0001）。我们生成了四级预后评分，以区分再照射后生存率极好（0 分）、良好（1 分）、中等（2 分）和较差（3±4 分）的患者。结果差异非常显着（p < 0.0001）。结论。我们根据三个临床相关因素生成了实用的预后评分指数，以预测患者从再照射中获益。该评分指标有助于患者咨询以及进一步临床试验的设计。然而，个体治疗决策可能包括其他不直接影响结果的患者相关因素。
Re-irradiation using high-precision radiation techniques has been established within the clinical routine for patients with recurrent gliomas. In the present work, we developed a practical prognostic score to predict survival outcome after re-irradiation. Patients and methods. Fractionated stereotactic radiotherapy (FSRT) was applied in 233 patients. Primary histology included glioblastoma (n = 89; 38%), WHO Grade III gliomas (n = 52; 22%) and low-grade glioma (n = 92; 40%). FSRT was applied with a median dose of 36 Gy in 2 Gy single fractions. We evaluated survival after re-irradiation as well as progression-free survival after re-irradiation; prognostic factors analyzed included age, tumor volume at re-irradiation, histology, time between initial radiotherapy and re-irradiation, age and Karnofsky Performance Score. Results. Median survival after FSRT was 8 months for glioblastoma, 20 months for anaplastic gliomas, and 24 months for recurrent low-grade patients. The strongest prognostic factors significantly impacting survival after re-irradiation were histology (p < 0.0001) and age (= 50, p < 0.0001) at diagnosis and the time between initial radiotherapy and re-irradiation 12 months (p < 0.0001). We generated a four-class prognostic score to distinguish patients with excellent (0 points), good (1 point), moderate (2 points) and poor (3 4 points) survival after re-irradiation. The difference in outcome was highly significant (p < 0.0001). Conclusion. We generated a practical prognostic score index based on three clinically relevant factors to predict the benefit of patients from re-irradiation. This score index can be helpful in patient counseling, and for the design of further clinical trials. However, individual treatment decisions may include other patient-related factors not directly influencing outcome.