The value of high-dose radiotherapy in intracranial ependymoma
The value of high-dose radiotherapy in intracranial ependymoma
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DOI：
10.1002/pbc.27697
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发表时间：
2019-06-01
影响因子：
3.2
通讯作者：
Poppe, Matthew M.
中科院分区：
文献类型：
--
作者：
Ager, Bryan J.;Christensen, Michael T.;Poppe, Matthew M.
背景：我们试图评估局部颅内室管膜瘤手术切除后辅助放疗剂量对总生存率（OS）的影响。程序查询了2004年至2015年美国国家癌症数据库（NCDB）中接受手术和4500至7000 cGy辅助放疗的所有年龄段颅内WHO II至III级室管膜瘤患者。采用Pearson卡方检验和多变量Logistic回归分析评估临床人口统计学因素和护理模式。在倾向评分匹配后，采用Kaplan-Meier分析和双稳健估计与多变量考克斯比例风险模型评估OS。结果1153例符合标准的患者中，529例（46%）接受了5400 cGy。在中位随访54.5个月时，在2-18岁的儿科患者中观察到> 5400 cGy的OS益处（风险比[HR] 0.53; 95%置信区间[CI] 0.28-0.99，P = 0.047）。年龄< 2岁的儿童患者（P = 0.819）或成人患者（P = 0.180）在5400 cGy之间未发现OS差异。年龄增加、WHO III级、次全切除和接受化疗预示着更差的OS。年龄2至18岁、WHO III级、幕上位置和接受化疗与接受> 5400 cGy相关。结论2-18岁WHO分级Ⅱ ~ Ⅲ级颅内室管膜瘤患儿辅助放疗剂量> 5400 cGy与OS改善相关。在成人或2岁以下儿童中，> 5400 cGy未发现OS获益。
Background We sought to evaluate the impact of adjuvant radiotherapy dose on overall survival (OS) after surgical resection for localized intracranial ependymoma. Procedure The National Cancer Database (NCDB) was queried from 2004 to 2015 for patients of all ages with intracranial WHO grade II to III ependymoma treated with surgery and 4500 to 7000 cGy of adjuvant radiotherapy. Pearson chi(2) test and multivariate logistic regression analyses were used to assess clinicodemographic factors and patterns of care. After propensity-score matching, OS was assessed with Kaplan-Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling. Results Of the 1153 patients meeting criteria, 529 (46%) received 5400 cGy. At a median follow-up of 54.5 months, an OS benefit was observed for > 5400 cGy in pediatric patients aged 2-18 years (hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.28-0.99, P = 0.047). No OS difference was found between 5400 cGy in pediatric patients aged < 2 years (P = 0.819) or in adults (P = 0.180). Increasing age, WHO grade III, subtotal resection, and receipt of chemotherapy portended worse OS. Age 2 to 18 years, WHO III grade, supratentorial location, and receipt of chemotherapy were associated with receiving > 5400 cGy. Conclusion Adjuvant radiotherapy dose > 5400 cGy was associated with improved OS for children aged 2-18 years with WHO grade II-III intracranial ependymoma. No OS benefit was found with > 5400 cGy in adults or children less than two years of age.