Hypofractionated stereotactic radiotherapy in the management of recurrent glioma
Hypofractionated stereotactic radiotherapy in the management of recurrent glioma
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DOI：
10.1016/s0360-3016(96)00455-5
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发表时间：
1997-01-15
影响因子：
7
通讯作者：
Brada, M
中科院分区：
文献类型：
--
作者：
Shepherd, SF;Laing, RW;Brada, M
目的：本研究旨在评价大分割立体定向放射治疗（hypofractionated stereotactic radiotherapy，SRT）治疗复发性胶质瘤的疗效和毒副反应。29例复发性高级别星形细胞瘤，3例高级别少突胶质细胞瘤，1例高级别室管膜瘤和3例毛细胞性星形细胞瘤。采用3个非共面弧或4 - 6个非共面固定射束，以5戈伊/次的剂量给予大分割立体定向放射治疗，剂量范围为20 - 50戈伊，初始剂量递增计划。2例患者接受20戈伊，8例接受30戈伊，10例接受35戈伊，10例接受30戈伊，5例接受35戈伊，1例接受50戈伊，治疗5天/周。与之相比，年龄、体能状态和初始组织学分级匹配的队列在复发时接受基于亚硝基脲的化疗的中位生存期为7个月（p < 0.05）。在单变量分析中，初始低级别星形细胞瘤组织学是唯一有利的生存预后因素。3例复发性少突胶质细胞瘤患者在SRT后分别存活11、23和34个月。三名儿童治疗复发毛细胞星形细胞瘤仍然活着14，41和55个月后SRT。在13名患者（36%）中观察到假定的辐射损伤（定义为可逆的类固醇依赖性毒性），2名患者（6%）需要再次手术。总剂量>40戈伊是放射损伤的主要预测因子（p < 0.005）。结论：大分割SRT是一种无创、耐受性好、以门诊患者为基础的姑息性、高剂量、局灶性照射方法。(C)1997年爱思唯尔科学公司
Purpose: This study aimed to assess the efficacy and toxicity of hypofractionated stereotactic radiotherapy (SRT) in the management of patients with recurrent glioma.Methods and Materials: From January 1989 to July 1994, 36 patients with glioma were treated at the time of recurrence. Twenty-nine had recurrent high-grade astrocytoma, 3 high-grade oligodendroglioma, 1 high-grade ependymoma, and 3 pilocytic astrocytoma. Hypofractionated stereotactic radiotherapy was given using either three noncoplanar arcs or four to six noncoplanar fixed beams at 5 Gy/fraction, to doses ranging from 20 to 50 Gy initially on a dose escalation program. Two patients received 20 Gy, 8 received 30 Gy, 10 received 35 Gy, 10 received 30 Gy, 5 received 35 Gy, and 1 received 50 Gy, treating 5 days/week.Results: The median survival of 29 patients with recurrent high-grade astrocytoma was 11 months from the time of SRT. This compared to a median survival of 7 months for a cohort matched for age, performance status, and initial histologic grade who received nitrosourea-based chemotherapy at recurrence (p < 0.05). Initial low-grade astrocytoma histology was the only favorable prognostic factor for survival on univariate analysis. Three patients with recurrent oligodendroglioma remain alive 11, 23, and 34 months after SRT. Three children treated for recurrent pilocytic astrocytoma remain alive 14, 41, and 55 months following SRT. Presumed radiation damage, defined as reversible steroid-dependent toxicity, was observed in 13 patients (36%) and required reoperation in 2 (6%). A total dose of >40 Gy was a major predictor of radiation damage (p < 0.005).Conclusion: Hypofractionated SRT is a noninvasive, well-tolerated, outpatient-based method of delivering palliative, high-dose, focal irradiation. (C) 1997 Elsevier Science Inc.