High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme
High-dose conformal radiotherapy influenced the pattern of failure but did not improve survival in glioblastoma multiforme
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DOI：
10.1016/s0360-3016(97)00911-5
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发表时间：
1998-03-15
影响因子：
7
通讯作者：
Akanuma, A
中科院分区：
文献类型：
--
作者：
Nakagawa, K;Aoki, Y;Akanuma, A
背景和目的：虽然多形性胶质母细胞瘤明显具有放射抗性，但有证据表明其存在剂量依赖性反应关系。材料与方法：1984~1995年，采用旋转多叶准直器（MCL）适形放射治疗颅内多形性胶质母细胞瘤38例。男25例，女13例，中位年龄47岁（12-73岁，平均46.5岁），中位Karnofsky评分80分（30-100分，平均78.2分）。中位肿瘤体积为64 cc（8 - 800 cc，平均110.3 cc）。所有患者均接受了手术治疗（仅活检1例，部分切除13例，次全切除21例，大体全切除3例）。1990年以前治疗的21例患者的放射剂量为60~80戈伊（中位数68.5戈伊，平均68.3戈伊），1990年以后治疗的17例患者的放射剂量为90戈伊。结果：1年、2年、5年和10年的总生存率分别为75%、42%、20%和15%。单因素分析显示，初始肿瘤体积、残留肿瘤体积和Karnofsky评分是影响生存率的统计学显著因素。多变量分析显示，只有残余肿瘤体积具有统计学意义。残留肿瘤体积小于或等于5cc的患者的5年生存率高达37%。90-戈伊组的生存率似乎低于低剂量组，尽管没有观察到统计学差异（3年生存率为40% vs. 22%）。在低剂量组的19例复发中有16例观察到局部失败，而在90-戈伊组的13例复发中只有4例观察到局部失败。失败模式的差异具有统计学意义。高剂量组2例发生放射性坏死，1例死亡。结论：高剂量适形放疗并不能提高生存率，但确实改变了失败的模式。(C)1998年爱思唯尔科学公司
Background and Purpose: Although glioblastoma multiforme is clearly radiation-resistant, there is evidence of a dose-dependent response relationship. The purpose of the study was to evaluate the impact of higher dose by rotational multileaf collimator (MCL) conformal radiation therapy.Materials and Methods: From 1984 to 1995, 38 consecutive cases with intracranial glioblastoma multiforme mere treated using the rotational MLC conformal therapy. There were 25 men and 13 women with a median age of 47 years (12-73 years, mean 46.5 years), Median Karnofsky performance score was 80 (30-100, mean 78.2). Median tumor volume was 64 cc (8-800 cc, mean 110.3 cc). All underwent surgical intervention (only biopsy in 1, partial resection in 13, subtotal resection in 21, and gross total resection in 3). Radiation dose to was 60 to 80 Gy (median 68.5 Gy, mean 68.3 Gy) in 21 patients treated before 1990 and 90 Gy in the 17 patients thereafter. Biweekly i.v. chemotherapy was also administered for both arms.Results: The I-year, 2-year, 5-year, and 10-year overall survival rates were 75%, 42%, 20%, and 15%, respectively. Univariate analysis showed the initial tumor volume, residual tumor volume, and Karnofsky performance score were statistically significant factors for survival. Only the residual tumor volume was statistically significant by multivariate analysis. The 5-year survival rate of patients with residual tumors of 5 cc or less in volume was as good as 37%. Survival of the 90-Gy Group appeared inferior to that of the Low-Dose Group, though no statistical difference was seen (the 3-year survival was 40% vs. 22%). Local failure was observed in 16 of the 19 recurrences in the Low-Dose Group, whereas it was observed in only 4 of the 13 recurrences in the 90-Gy Group. The difference in pattern of failure was statistically significant. Two patients of the High-Dose Group developed radiation necrosis and one died of it.Conclusions: The high-dose conformal radiotherapy did not improve survival in the disease, but did change the pattern of failure. (C) 1998 Elsevier Science Inc.