高级别脑胶质瘤术后低分割同期推量调强放疗的初步研究

A preliminary study of post-operative high grade gliomas undergoing low fractionated intensity-modulated radiotherapy

目的探讨高级别脑胶质瘤术后采用低分割同期推量调强放疗的临床疗效、安全性及预后影响因素。方法 2013年8月至2016年3月期间我科共治疗术后病理证实为高级别脑胶质细胞瘤的患者37例,术后放疗统一采用低分割同期推量调强放疗方式,放疗期间同步口服替莫唑胺化疗,放疗后4 w开始行辅助替莫唑胺化疗共6个周期。结果 1年、2年、3年总生存率分别为81.1%、77.4%、62.1%,其中Ⅳ级分别为63.2%、56.1%、42.1%;1年、2年、3年无疾病进展生存率分别为71.0%、64.5%、38.7%,其中Ⅳ级分别为57.4%、50.2%、25.1%,Ⅲ级1年、2年无疾病进展生存率分别为83.3%、64.5%。单因素分析显示,年龄、病理分级、是否同步替莫唑胺与总生存率(overall survival,OS)相关。多因素分析提示,是否同步替莫唑胺、病理分级与OS相关。全组患者无4级以上急性不良反应,多为1~2级,经对症处理均可缓解。结论低分割同步推量调强放疗方式治疗高级别脑胶质瘤能够获得理想的近期临床疗效,且不良反应耐受度好,是一种有效的治疗方式。患者年龄、病理分级、是否同步替莫唑胺是重要的预后因素。

Objective The clinical efficacy,safety and the factors affecting prognosis of high grade glioma surgery treated with low-fractionated simultaneous integrated boost intensity-modulated radiotherapy were investigated.Methods This study included 37 high grade gliomas patients admitted to our institute between August 2013 and March 2016. Radiotherapy with low-fractionated simultaneous integrated boost intensity-modulated radiotherapy therapy（ IMRT） was performed after operation. Synchronization during radiotherapy for temozolomide（ TMZ） oral chemotherapy,6 cycles TMZ chemotherapy started at 4 w after radiotherapy. Results One-year,2-year,3-year total survival rates were 81. 1%,77. 4%,and 62. 1% including 63. 2%,56. 1% and 63. 2% for Grade IV gliomas,respectively. One-year,2-year,3-year without disease progression survival rates were 71. 0%,64. 5%,and 38. 7%,including 57. 4%,50. 2%,and 25. 1% for Grade III gliomas,respectively. For Grade III gliomas,1-year and 2-year without disease progression survival rates were 83. 3% and 64. 5%,respectively. Single factor analysis showed that age,pathological stage,whether with synchronous temozolomide were associated with the OS. No acute adverse reactions above Grade Ⅳ appeared in the whole group patients,and most GradeⅠ~Ⅱgliomas could be alleviated by symptomatic treatment. Conclusion Low-fractionated simultaneous integrated boost intensity-modulated radiotherapy can obtain ideal recent clinical curative effect and better tolerance,so it is an effective way of treatment. Age,pathological grading,and with/without synchronous TMZ are the important prognostic factors.