脑多形性胶质母细胞瘤水肿带大小与预后相关性的分析

The Potential Correlation between the Size of Peripheral Edema and Prognosis of Glioblastoma Multiforme

目的评价肿瘤外周水肿带对脑多形性胶质母细胞瘤(GBM)的预后影响。方法回顾性分析74例接受适形放射治疗(CRT)多形性胶质母细胞瘤患者的资料。所有患者均经病理组织学证实,其中62例患者经手术全切或次全切术,12例仅行立体定向活检术。55例采用了不同方式的化疗,另外19例患者行单纯放疗,放疗剂量均为60Gy。结果中位生存期为13.9个月,1、2及3年总生存率分别为57.0%、18.0%和12.9%。水肿带最大径≤70mm者中位生存期为19.9个月,>70mm者为9.9个月(P<0.0001);水肿带与肿瘤最大径比值(E/T)≤1.8与>1.8者中位生存期分别为16.6个月和9.9个月(P=0.0004)。中位肿瘤进展时间为7.8个月,1、2年的局部控制率分别为22.4%和8.2%。结论肿瘤边缘水肿带大小以及与肿瘤的比值是影响GBM预后的重要因素,提示水肿带应包括在照射野内,同时在不增加并发症的前提下是否应进一步提高水肿带照射剂量?

Objective To evaluate t the potential correlation between the size of peripheral edema and prognosis of glloblastoma multlforme. Methods Seventy-four patients with newly diagnosed GBM patients treated with CRT were analyzed retrospectively. All patients underwent surgery,total or subtotal resection in 62 cases,biopsy only in 12.55 patients received CRT combined with various chemotherapy and 19 patients treated with CRT alone. The most common dose of CRT delivered was 60 Gy in 30 fractions. Results The median overall survival was 13.9 months with 1-year,2-year and 3-year survival rate of 57.0%, 18.0% and 12.9 % ,respectively. Patients with small edema （diameter ≤ 70 mm） had longer survival （19.7 months vs. 9.6 months in those 〉 70 mm） （P 〈 0. 0001）. And the ratio of edema/gross tumor≤1. 8（P = 0. 0004） inducted better outcome. The median time to tumor progression was 7.8 months （range 6.1 to 9.3 months）. The actuarial 1 year and 2 years local control rates were 22.4% and 8.2 %, respectlvely.Conclusion The size of edema and ratio of edema/tumor is survival predictor for GBM. It is may suggest that the peripheral edema region should be included in the radiation volume and a high enough dose with permission of neurotoxlcity should be delivered.