低分割放射治疗分次γ-刀治疗后局部复发脑胶质瘤的疗效观察

Clinical observation of low fractionated radiation on local recurrent gliomas

目的探讨三维适形低分割放射治疗分次γ-刀治疗后复发脑胶质瘤的临床疗效。方法收集接受分次γ-刀治疗后局部复发脑胶质瘤25例,单次分割剂量2.5Gy,总剂量30~50Gy;病理分级:Ⅱ、Ⅲ、Ⅳ分别包括5、8、12例。结果随访2~24个月,随访率100%;放射性脑水肿发生率56%;近期疗效:CR12%、PR32%、NC36%、PD20%;1年生存率40.0%,2年生存率16%。单因素分析显示,KPS评分≥60分(X^2=15.122,P=0.000)、病理分级(X^2=10.678,P=0.005)、复发时间大于4个月(X^2=8.957,P=0.003)均与预后具有相关性。多因素Cox回归性分析显示,KPS评分和病理分级与预后具有相关性。结论低分割放疗是治疗分次伽玛刀治疗后复发脑胶质瘤的有效方法,副作用有叠加效果,KPS评分和病理分级是独立预后因素。

Objective To investigate the clinical efficacy of low fractionated radiation on local recurrent gliomas. Methods 25 local recurrent gliomas patients after Gamma knife treatment were treated with low fractionated radiation （single dose： 2.5Gy/d, total dose： 30Gy-50Gy）. Results The follow-up rate was 100%. The incidence of radiation-induced cerebral edema was 56%. The CR, PR, NC and PD were 12%, 32%, 36% and 20% . 1-year survival rate and 2- year survival rate were 40% and 16%. KPS≥60, time of recurrence ≥4 months and pathological grade were related to prognosis by univariate analysis. Multivariate COX regression analysis showed Karnofsky ≥60 score and low pathological grade could significantly prolong overall survival time of patients. Conclusion Curative effect of recurrent gliomas of fractionated stereotactic radiotherapy on three-dimensional conformal hypofractionated is definite. The radiation side effects of it can be tolerated. Karnofsky and pathological grade is independent prognostic factor.