X线立体定向放射治疗脑恶性胶质细胞瘤的研究

The randomized research of X-ray stereotactic radiosurgery for brain malignant glioma

目的 探讨X线立体定向放射治疗在脑恶性胶质细胞瘤 (BMG)治疗中的作用。方法 1996年 10月～ 1998年 10月 ,112例CT或MRI证实术后病灶残瘤的BMG随机分为单纯常规放射治疗组 (单放组 )和常规放射治疗 +X线立体定向放射治疗 (立体定向放疗组 )。单放组 5 8例 ,男 40例 ,女 18例 ,年龄 16～ 76岁 (中位 40 .5岁 ) ,KPS6 0～ 70者 12例 ,>70者 46例 ;放疗前增强CT或MRI显示 ,肿瘤体积 1.0 0cm3 ～ 2 14 .78cm3 ,中位体积 2 1.0 0cm3 ;常规剂量分割照射 ,5次 /周 ,1.8～ 2Gy/次 ,总剂量 46 .2 0～ 6 5 .95Gy ,中位剂量 5 7.81Gy。立体定向放疗组共 5 4例 ,男 39例 ,女 15例 ,年龄 16～ 78岁 (中位年龄 44.5岁 ) ;KPS6 0～ 70者 8例 ,>70者 76例 ;肿瘤体积 1.76cm3 ～ 132 .0 0cm3 ,中位体积 2 2 .32cm3 ;先行常规照射 ,其照射野设计及其剂量分割与单放组相同 ,总剂量 45 .80～ 6 2 .45Gy ,中位剂量 5 5 .2 6Gy ;于常规放疗结束后 1周行立体定向放疗 ,采用非共面弧形旋转照射 ,PTV边缘剂量 8Gy～ 5 0Gy( 6 0 %～ 90 %等剂量曲线 ) ,中位 2 7.75Gy ;单次治疗 2 2例 ,分两次治疗者 2 8例 ,三次分割治疗者 6例 ,分次治疗的时间间隔为 1周 ;单次剂量 8Gy～ 5 0Gy ,中位单次剂量 15Gy。结果 治疗结束后 3个月CT?

Objective To evaluate the role of X-ray stereotactic radiosurgery combined with the conventional external radiotherapy in the treatment of brain malignant glioma(BMG).Methods From October 1996 to October 1999,112 patients with residual BMG identified by CT scan or MRI were randomized into conventional external radiotherapy group(external radiotherapy group)and conventional external radiotherapy combined with X-ray stereotactic radiosurgery (stereotactic radiosurgery group).In external radiotherapy group,there were 40 males and 18 females,ranging from 16 to 76 years with a mean of 40.5.Tumor volume of 1.00cm 3～214.78cm 3 with a median of 21.00cm 3 was displayed by contrasted CT scan or MRI.The total dose ranged 46.20～65.95Gy with a median of 57.81Gy.In stereotactic radiosurgery group,there were 39 males and 15 females,aging 16～78 years with a median of 44.5.Tumor volume of 1.76cm 3 to 132.00cm 3 with a median of 22.32cm 3 was showed by contrasted CT scan or MRI.All of the patients in the stereostactic radiosurgery group were irradiated firstly by conventional dose fraction to a total dose of 45.80～62.45Gy with a median of 55.26Gy.One week after the conventional external radiotherapy,the X-ray stereotactic radiosurgery was carried out with noncoplanar arc irradiation,the dose at PTV margin ranged 8～50Gy,and 60%～90% isodose curve completely included the PTV,the median dose being 27.75Gy.Twenty-two patients were treated by one fraction,28 patients by two fraction,and 6 patients by three fraction,one fraction dose ranged 8～50Gy with a median dose of 15Gy.Results Three months after treatment,CT scan or MRI showed that,the tumor regression rate and 1 year survival rate in the stereotactic radiosurgery group was significantly higher than that in the external radiotherapy group,44.44% and 22.40%,48.15% and 25.86%,respectively.The 1-year tumor recurrent rate of the patients with CR in the conventional external radiotherapy group was significantly higher than that in the stereotactic radiosurgery group,30.77% and 12.50%,respectively.The rate of acute radiation toxicity for the patients irradiated by equal or more than 35Gy was significantly higher than that for the patients irradiated by less than 35Gy.Conclusion X-ray stereotactic radiosurgery combined with conventional external radiotherapy can increase the local tumor regression rate,local tumor control rate of BMG,and 1-year survival rate but the rate and degree of acute radiation toxicity were increased accordingly.Thus the single fraction dose of stereotactic radiosurgery on BMG should be less than 35Gy.