脑胶质瘤术后三维适形放射治疗疗效32例初步分析

Preliminary Analyses of the Outcome on Postoperative Three-Dimensional Conformal Radiotherapy for 32 Patients with Brain Glioma

背景与目的:三维适形放射治疗(3DCRT)有别于传统二维放射治疗,它能够对靶区施以精确照射, 并且能减少靶区周围重要器官和正常组织受照射的体积和剂量。本研究拟对脑胶质瘤患者术后采用3DCRT 治疗的疗效及放射毒性反应进行初步分析。方法:接受术后3DCRT治疗的脑胶质瘤患者共32例,其中低分级 (LGG)和高分级(HGG)胶质瘤各为14和18例。中位放射剂量60Gy(50-81Gy),设3-4个野作非共面等中心照射。结果:中位随访时间为15.2个月(4.4-34.6个月),全组肿瘤复发9例(LGG1例,HGG8例),死亡8例 (LGG1例,HGG7例)。1、2年总生存率(OS)分别为89.4%和63.2%,1、2年无进展生存率(PFS)分别为78.5% 和59.4%。LGG和HGG的2年OS分别为92.3%和32.1%(P=0.0156),2年PFS分别为92.3%和0(P=0.0027)。 3级以上急、慢性放射反应的发生率分别为9.4%(3/32)和12.5%(4/32)。结论:3DCRT治疗脑胶质瘤术后患者的毒性是可接受的,对低分级胶质瘤具有良好的疗效,但对高分级胶质瘤的疗效尚不满意,有待进一步研究。

BACKGROUND ＆ OBJECTIVE： Three-dimension conformal radiotherapy （3DCRT） differs from conventional 2-dimension radiotherapy. It allows for precise irradiation to the target and decreases the volume and dose of critical organs and normal tissue close to target. This study was to preliminarily analyze the efficacy and toxicity of 3DCRT for postoperative patients with brain glioma. METHODS： Thirty- two patients with brain glioma received 3DCRT after operation. Among them, 14 patients had low-grade gliomas （LGG）, and 18 patients had high-grade gliomas （HGG）. Median total dose of 60Gy （50-81Gy） was delivered by 3-4 fields using non-coplanar isocenter irradiation. RESULTS： Median following time was 15.2 months （4.4-34.6 months）. Nine patients （1 for LGG and 8 for HGG） recurred and 8 patients （1 for LGG and 7 for HGG） died. Overall survival （OS） was 89.4% at 1 year and 63.2% at 2 years; progression-free survival （PFS） was 78.5% at 1 year and 59.4% at 2 years for all patients, respectively. There were significantly differences between LGG and HGG at 2-year OS, being for 92.3% and 32.1% （P=0.0156）. And at 2-year, PFS were 92.3% in LGG and 0 （P=0.0027） for HGG, respectively. The incidence of acute and late toxicity grade ≥3 was 9.4% （3/32） and 12.5% （4/32）, respectively. CONCLUSION： 3DCRT is a safe modality with tolerable toxicity for postoperative brain gliomas. The therapeutic efficacy is favorable for LGG, but not yet satistied for HGG. Further studies are needed.