恶性胶质瘤常规放疗与三维适形放疗的疗效比较  

A comparative study on the therapeutic efficacy of conventional radiotherapy and three dimensional conformal radiotherapy for malignant glioma

作　　者：王孝深[1] 胡超苏[1] 何霞云[1] 应红梅[1] 朱国培[1] 吴永如[1] 冯炎[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科、复旦大学上海医学院肿瘤学系,上海200032

出　　处：《肿瘤》2008年第12期1069-1073,共5页Tumor

摘　　要：目的:回顾性比较恶性胶质瘤常规放疗与三维适形放疗的疗效。方法:1997年1月—2007年5月在本院接受术后放疗的152例恶性胶质瘤患者。根据放疗方法分为常规放疗(85例)和三维适形放疗(67例)。常规放疗组全脑或者次全脑放疗36～40Gy后缩野,针对肿瘤床加量至56～60Gy;三维适形放疗采用CT/MRI融合法描画靶区,MRIT2加权FLAIR序列显示的高信号区即为可见肿瘤区,给予放射剂量60Gy,高信号区外放2cm即为临床靶区,给予放射剂量50～54Gy。常规放疗和三维适形放疗的分割放射剂量均为2.0Gy/fx,1次/d,每周5次。分析放疗后的疗效,并比较失败模式。结果:常规放疗组和三维适形放疗组的3年总生存率分别为22.9%和31.9%(χ2=1.01,P=0.31),2组放射性高颅压的发生率分别为47.1%和31.3%(χ2=3.95,P=0.04)。三维适形放疗组45例肿瘤复发均位于肿瘤区和临床靶区范围内。结论:恶性胶质瘤三维适形放疗降低了放射性高颅压的发生率。三维适形放疗的范围包括MRIT2FLAIR序列显示的高信号区外放2cm的边界是可行的。Objective： To compare the efficacy of conventional radiotherapy and three dimensional conformal radiotherapy （3 D-CRT） for malignant glioma retrospectively. Methods： From January 1997 to May 2007, 152 patients with malignant glioma received postoperative radiotherapy at our hospital. Patients were classified into two groups according to the radiotherapy techniques. Group A （ n = 85） received conventional whole brain or subtotal brain irradiation at 36-40 Gy followed by a boost of 20 Gy to the tumor bed. Group B （3D-CRT group, n =67） were given 50-54 Gy of irradiation in the clinical target volume （CTV） and 60 Gy of irradita-tion in the gross tumor volume （GTV）. GTV was defined as the high signal area on T2 weighted FLAIR MRI image, and CTV was defined as GTV plus a 2-cm margin. The fraction dose for both conventional chemotherapy and 3D-CRT was 2.0 Gy/fx, once a day, five times per week. The efficacies of both ratiotherapy were compared and the failure mode was analyzed. Results： The 3-year overall survival rates were 22.9% and 31.9% in group A and group B, respectively （χ^2 = 1.01, P = 0.31 ）. Incidence of increased intracra-nial pressure were 47.1% and 31.3 % in group A and group B, respectively（χ^2 = 3.95, P = 0.04）. All the tumor recurrence was detected within the range of GTV and CTV in 45 patients in group B. Conclusion： 3 D-CRT reduces the incidence of radiation-induced high intracranial pressure of malignant glioma patients compared with conventional radiotherapy. The irradiation volume including the high signal area on T2 FLAIR MR imaging plus a 2-cm margin is feasible in 3D-CRT.

关 键 词：神经胶质瘤 放射疗法 磁共振成像 

分 类 号：R739.41[医药卫生—肿瘤]