143例脑胶质瘤立体定向加常规放疗的疗效观察

Postoperative stereotactic radiotherapy supplementing conventional irradiation in the treatment of 143 patients with brain glioma

目的采用立体定向放疗与常规放疗结合治疗胶质瘤,分析其疗效并探讨其影响预后的因素。方法对143例脑胶质瘤患者采用立体定向放疗与常规放疗相结合方法。立体定向放疗针对GTV追加剂量,5～7 Gy/次,共5～7次。常规放疗主要针对亚临床病变,一般剂量为50Gy。寿命表法统计生存率。结果全组患者治疗3～6个月后KPS评分为81±9,与术前的71±9比较有明显改善(t=5．98,P＜0．01)。CR 39例(27．3%),PR 70例(49．0%),NC 25例(17．5%),PD 9例(6．3%),有效率为76%。1、3、5年生存率分别为56．6%、36．0%和21．7%。预后因素分析结果显示低分级胶质瘤的患者预后好,而年龄、肿瘤部位、治疗剂量等因素与预后无关。结论立体定向放疗加常规放疗治疗胶质瘤既发挥了放射物理剂量分布的优点,又符合放射生物学原则,较以往治疗提高了患者的生存机会。

Objective To analyze the results of postoperative conventional radiotherapy supplemented by stereotactic radiotherapy for glioma and with analysis of prognostic factors. Methods From Dec. 1998 to Dec. 2004,143 patients with brain glioma were postoperatively treated with conventional radiotherapy supplemented by stereotactic radiotherapy. Steretactic radiotherapy of 5-7 Gy/fraction, to totally 5-7 fractions were added as boost to the GTV following the conventional radiotherapy. The conventional radiotherapy, aiming at the peri-tumoral subclinical micro-foci, was about 50 Gy. Results The KPS grades were 81 ± 9 , 71 ± 9 in patients 3-6 month after treatment in contrast to that prior to operation（t = 5.98 ,P 〈 0.01 ）. CR 39 patients （27.3%） ,PR 70 patients（49.0% ） ,NC 25 patients（ 17.5% ） ,PD 9 patients（6.3% ）, with an efficiency rate of 76%. The 1-, 3-, and 5-year survival rate was 56.6% , 36.0% and 21.7% , respectively. Prognostic factor analysis showed that patients with low grade glioma had better survival time. Age, tumor site and dose, etc were unrelated to prognosis. Conclusion Stereotactic radiotherapy supplementing conven- tional radiotherapy is effective for postoperative brain glioma, which method not only shows excellence in physical dose distribution but strictly in accordance with the principle of radiobiology also.