脑胶质瘤术后调强放射治疗的效果评价

THE EFFECT APPRAISAL OF THE BRAIN GLIOMAS TREATED WITH INTENSITY MODULATED RADIOTHERAPY

目的:脑胶质瘤是原发于颅内最常见的一种肿瘤。以手术为主的综合治疗是目前的主要治疗手段。术后放疗可提高局部控制率。方法:回顾性分析收集的经病理证实为胶质瘤的60例病人。术后均采用调强放射治疗或适形放射治疗技术,Ⅰ、Ⅱ级胶质瘤放疗剂量以54Gy为分界,分为两组,比较两组1、2、3a生存率及P值,Ⅲ、Ⅳ级胶质瘤放疗剂量60Gy为界分为两组,比较两组1、2、3a生存率及P值。结果:平均随访时间为18个月(6-36),Ⅰ、Ⅱ级胶质瘤两组1a生存率无明显差异,2、3a生存率有明显差异,P值小于0.1,有统计学意义。Ⅲ、Ⅳ级胶质瘤1a、3a生存率无明显差异,2a生存率有明显差异,但无统计学意义。采用三维适形放疗技术及调强适形放疗技术1、3a生存率有差异,但无统计学意义。结论:脑胶质瘤术后采用调强放射治疗,低级别胶质瘤,治疗剂量可以影响胶质瘤病人的2a、3a生存率。高级别胶质瘤治疗剂量对病人的生存率无明显影响。

Objective：Brain Glioma is the commonest primary intracranial tumors.Surgery is the mainly treatment for Gliomas and radiotherapy after operation can improve local control rate.Methods：All of 60 patients were treated with radiotherapy after operation.They were treated with intensity modulated radiotherapy（IMRT）or conformal radiotherapy（CRT）.Patients with low-degree gliomas were divided into higher dose group（≥54Gy）and lower dose group（〈54Gy）,while high degree gliomas into higher dose group（≥60Gy）and lower one（60Gy）,Comparing overall survival rate and toxicities associated with radiotherapy between higher dose cohort and lower one,respectively.Results： The median follow-up time was 18 months（range 6~36months）.One year survival rate of patients with a grade Ⅰand Ⅱ gliomas was no difference between groups,while 2,3 year survival rate was significant difference statistically（P〈0.1）.For the patients with grade Ⅲ and Ⅳ gliomas,1,3 year survival rate was no marked difference,but 2 year survival was significant difference between dose groups.The 1,3 year survival rate between 3DCRT and IMRT cohorts was difference,but no statistical significance.Cerebropathy associated with radiotherapy increases along with the dose enhancing.Conclusion：IMRT with further dose escalation after surgery will improve 2,3 year survival rate for the patients with low-degree glioma.Further dose escalation is not different survival rate for the patients with high-degree gliomas.