脑胶质瘤术后常规放疗和三维适形放疗的同期对照研究

Treatment outcomes of different radiotherapies for postoperative gliomas:three-dimensional conformal radiotherapy versus conventional radiotherapy

目的:对比分析脑胶质瘤术后常规放疗和三维适形放疗的远期疗效,以探索更好的术后放疗方法。方法:对2001年1月至2010年12月在本院接受放疗的83例脑胶质瘤患者进行回顾性分析。采用Kaplan-Meier法计算无进展生存率和总生存率,并应用Log-rank检验进行比较;应用卡方检验比较两组的一般情况、不良反应发生情况等指标差异。结果:所有83例患者3年总生存率和无进展生存率分别为76.3%和72.2%,术后三维适形放射治疗组及常规放射治疗组3年总生存率、无进展生存率分别为82.5%、78.2%和66.9%、64.1%(P=0.015、0.018)。分层分析显示三维适形放射治疗主要提高了手术未完全切除肿瘤患者以及病理分级为Ⅲ～Ⅳ级患者的无进展生存率和总生存率。结论:与术后常规放疗相比,术后三维适形放疗提高了脑胶质瘤的无进展生存率和总生存率,并可以减少放射性不良反应的发生。

Objective： We aimed to compare the efficacy and side effects of three-dimensional conformal radiotherapy （3DCRT） and conventional radiotherapy for treating postoperative gliomas. Methods： We retrospectively analyzed the data of 83 cases of postoperative gliomas that received radiotherapy from January 2001 to December 2010 in our hospital. The Kaplan Meier method was used to calculate the tumor-free survival and overall survival （OS） rate. The log-rank test was conducted to determine significance. The chi-squared test was used to compare the differences among the clinical characteristics and toxicity. Results： The OS and progression-free survival （PFS） rates for 3 years of all 83 cases were 76.3% and 72.20, respectively. The OS and PFS for 3 years were 82.5% and 78.2% for 3DCRT, as well as 66.9% and 64.1% for conventional radiotherapy. Stratified analysis showed that 3DCRT mainly improved the OS and PFS rates of residual glioma and higher-grade （pathological grades Ⅲ - Ⅳ） gliomas. Conclusion： Higher OS and PFS rates, lower incidence of herniation, and more delayed radiation-induced brain injury were achieved with 3DCRT than with conventional radiotherapy.