复发脑胶质瘤再程放疗的远期疗效分析

Analysis of long-term efficacy of re-irradiation for recurrent glioma

目的分析复发脑胶质瘤行再程放疗的远期疗效及不良反应。方法收集2009-2019年间行再程放疗的52例复发脑胶质瘤患者的资料,再程放疗中位计划靶区体积(PTV)73.5cm3(49.9~102.7cm3),中位剂量45.0Gy(43.0~48.8Gy)。Kaplan-Meier法计算总生存(OS)和无进展生存(PFS)期并Log-rank检验,Cox模型多因素预后分析。结果中位随访32.6个月,全组患者中位OS和中位PFS期分别为16.1个月(95%CI为4.1~28.1)和8.0个月(95%CI为4.0~12.0),1、2、3年OS率分别为67%、43%、29%,6个月、1年、2年PFS率分别为67%、40%、26%。多因素分析KPS评分、复发时间显著影响OS(P=0.012、P=0.001);KPS评分、两次放疗间隔时间显著影响PFS(P=0.003、P=0.018)。分层分析提示再放疗时KPS评分为初始病理WHOⅡ级和复发后再次手术患者OS及PFS的影响因素(P<0.001,P=0.012);复发时临床表现为初始病理WHOⅢ、Ⅳ级患者OS及PFS的影响因素(P=0.006、P=0.044)。不良反应总发生率为30.8%,1级占25.0%,2级占5.8%。结论再程放疗复发脑胶质瘤具有较好的远期疗效,不良反应可耐受。

Objective To analyze the long-term efficacy and safety of re-irradiation for recurrent glioma.Methods The data of 52 patients with recurrent gliomas were collected from 2009 to 2019.The median planned targetvolume(PTV)was 73.5 cm3(49.9-102.7 cm3)and the median dose was 45.0 Gy(43.0-48.8 Gy).Kaplan-Meier method was used for survival assessment,log-rank test for difference assessment,and Cox’s regression model for multivariate prognostic analysis.Results The median follow-up time was 32.6 months.The median overall survival(OS)and progression-free survival(PFS)time were 16.1 months(95%CI,4.1-28.1)and 8.0 months(95%CI,4.0-12.0).The 1-,2-and 3-year survival rates were 67%,43%and 29%,respectively.The 6-month,1-year and 2-year PFS rates were 67%,40%,26%,respectively.Multivariate analysis showed that KPS score and recurrence time significantly affected the OS(P=0.012,P=0.001).KPS score and time interval between two radiotherapies significantly impacted the PFS(P=0.003,P=0.018).Stratified analysis showed that KPS score was the independent prognostic factor of OS and PFS in patients with WHO gradeⅡinitial pathology and reoperation after recurrence(P<0.001,P=0.012);clinical manifestation was the independent prognostic factor of OS and PFS in patients with WHO gradeⅢandⅣinitial pathology(P=0.006,P=0.044).The overall incidence of adverse reactions was 30.8%.Grade 1 adverse reactions accounted for 25.0%,and 5.8%for grade 2.Conclusions Re-irradiation for recurrent glioma yields good long-term clinical efficacy and tolerable adverse reactions.