69例脑胶质瘤术后三维适形放射治疗临床分析

Three Dimensional Conformal Radiotherapy in the Treatment of Gliomas:Analysis of Sixty-nine Cases

背景与目的:胶质瘤是成人最常见的颅内肿瘤,其治疗首选以手术为主的综合治疗方案,术后辅助放射治疗是提高疗效的关键。本文旨在探讨脑胶质瘤术后辅助三维适形放射治疗的疗效及其预后因素。方法:69例脑胶质瘤术后的患者,均接受三维适形放射治疗,低级别胶质瘤95%PTV1中位剂量为49.8Gy,95%PTV2中位剂量为56Gy;高级别胶质瘤95%PTV1中位剂量为49.95Gy,95%PTV2中位剂量为60Gy。其中15例患者同步口服替莫唑胺,40例患者口服司莫司汀。结果:全组患者失访3例,死亡32例。1、3、5年生存率分别为68.1%,47.8%和41.8%,中位生存时间17个月。WHOⅠ级、Ⅱ级、Ⅲ级和Ⅳ级患者的3年生存率分别为100%、78.7%、45.0%和25.7%,肿瘤血供较为丰富和血供一般的患者的3年生存率分别为16.3%和81.2%,肉眼全切组和肿瘤残留组的3年生存率分别为64.1%和32.4%。结论:病理分级和肿瘤血供显著影响胶质瘤患者生存,肉眼全切肿瘤有助于提高疗效。

BACKGROUND OBJECTIVE： Glioma is the most common primary brain tumor in adult.The current standard treatment for gliomas is microsurgery resection to the extent feasible,followed by adjuvant radiotherapy and chemotherapy.In this study,we analyzed the effectiveness of three dimensional conformal radiotherapy in the treatment of gliomas.METERIALS and METHODS： A total of 69 gliomas received three dimensional conformal radiotherapy in our department.The medial radiation dose of PTV1 and PTV2 were 49.80Gy and 56.00Gy in low-grade gliomas,and 49.95Gy and60Gy in high-grade gliomas,respectively.There were 15 patients who received concurrent Temozolomide and 40 patients who received concomitant Semustine.RESULTS： The medial survival was 17 months.1-,3-and 5-year survival rate were 68.1%,47.8% and 41.8%,respectively.The 3-year survival rate of WHO grade Ⅰ,Ⅱ,Ⅲ and Ⅳ were 100%,78.7%,45.0% and 25.7%,respectively.The 3-year survival rate of the patients with rich and common blood supply were 16.3% and 81.2%,respectively.CONCLUSON： The high-grade glioma and rich blood supply predict poor prognosis.And gross total resection may be a good prognostic factor.