Patterns of Intracranial Glioblastoma Recurrence After Aggressive Surgical Resection and Adjuvant Management: Retrospective Analysis of 43 Cases
Patterns of Intracranial Glioblastoma Recurrence After Aggressive Surgical Resection and Adjuvant Management: Retrospective Analysis of 43 Cases
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DOI：
10.2176/nmc.52.577
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发表时间：
2012-08-01
影响因子：
1.9
通讯作者：
Okada, Yoshikazu
中科院分区：
文献类型：
--
作者：
Konishi, Yoshiyuki;Muragaki, Yoshihiro;Okada, Yoshikazu
本回顾性研究评价了43例连续成人颅内胶质母细胞瘤侵袭性手术切除后的复发模式。22例和21例增强病灶切除率分别为100%和95-99%。所有患者术后均接受分次放疗（60戈伊，30次），其中25例加化疗，18例加疫苗治疗。在随访期间（中位17个月），33例患者发现肿瘤复发，最常见的是切除腔壁内的区域（20例）。区域性或边缘性肿瘤进展患者组（N = 22）与远处或多次复发患者组（N = 8）之间无显著临床因素差异。两组间无进展生存期无显著差异（p = 0.27）。然而，局部或边缘性肿瘤进展患者的总生存率显著延长（p = 0.04），术后1年和2年分别为90%和54%，而远处或多次复发患者的总生存率分别为75%和0%。颅内胶质母细胞瘤的侵袭性手术切除和辅助治疗可能会改变其复发模式。大约一半的患者肿瘤进展出现在切除腔壁或距其边缘2 cm内。
The present retrospective study evaluated the recurrence patterns after aggressive surgical removal of intracranial glioblastomas in 43 consecutive adult patients. The resection rate of the enhanced lesion on magnetic resonance imaging was 100% and 95-99% in 22 and 21 cases, respectively. All patients received postoperative fractionated radiotherapy (60 Gy in 30 fractions) with additional chemotherapy (25 cases) or vaccine therapy (18 cases). During follow-up (median 17 months), tumor recurrence was identified in 33 patients, most frequently regional within the wall of the resection cavity (20 cases). No clinical factor differed significantly between the groups of patients with regional or marginal tumor progression (N = 22) and patients with distant or multiple recurrences (N = 8). Progression-free survival did not differ significantly between these two groups (p = 0.27). However, overall survival was significantly longer (p = 0.04) in patients with regional or marginal tumor progression, and constituted 90% and 54% at 1 and 2 years after surgery, respectively, compared to 75% and 0% in patients with distant or multiple recurrences. Aggressive surgical resection and adjuvant management of intracranial glioblastoma may change its recurrence pattern. Tumor progression appears in the wall of the resection cavity or within 2 cm from its margin in approximately half of patients.