19例复发性高分级胶质瘤再程放疗的经验  

Re-irradiation of 19 Cases of Recurrent High- grade Gliomas

作　　者：汪洋[1] 盛晓芳[1] 董伟[1] 高伟[1] 倪春霞[1] 戴嘉中[1] 孙磊[1] 潘力[1] 

机构地区：[1]复旦大学附属华山医院脑病中心,上海伽玛刀医院肿瘤放疗中心,上海市200235

出　　处：《中国肿瘤临床》2011年第20期1271-1274,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:回顾性分析采用1MRT技术再程放射治疗加或不加化学治疗后,复发性高分级胶质瘤(HGG)患者的不良反应、近期疗效和生存率。方法:2007年1月～2009年12月19例复发性HGG患者接受再程常规分割放射治疗,两次放射治疗间隔时间为9～156个月,中位32个月;剂量为40～60Gy,17～30fx,28～45d,中位剂量48Gy,24fx,35d;放射治疗采用IMRT技术;按L-Q模式计算等效生物剂量;记录放射治疗不良反应和近期疗效,计算总体生存率、无局部复发生存率和无放射坏死生存率。结果:本组BED_(α/β=10)中位值58Gy(48～72Gy)。急性反应主要是消化道反应、头痛和神经功能障碍加重,为1～2级,经对症治疗能明显减轻,未发现3级以上急性反应;有5例发生后期放射性脑坏死;PR 3例,SD 13例,PD 3例;KPS提高5例,不变10例,下降4例。1、2年总体生存率为62.4%和34.0%;间变性星型细胞瘤和胶质母细胞瘤的中位生存时间分别为11个月和10个月;1、2年无局部复发生存率为45.6%和26.1%;1、2年无放射坏死生存率为68.8%和55.0%。结论:初步结果显示采用IMRT技术和合适的放射剂量(中位BED_(α/β=10)58Gy)再程放射治疗加或不加化学治疗治疗复发性HGG安全有效。但本组病例数较少,值得进一步探索。Objective： To retrospectively analyze the toxicity, short-term effects, and survival rate of patients with recurrent high-grade gliomas after re-irradiation with intensity-modulated radiation therapy （ IMRT ） with or without chemotherapy. Methods： From January 2007 to December 2009, 19 patients with recurrent gliomas were re-irradiated with conventional fractionated IMRT. The interval between radiation courses was 9-156 months （ median： 32 months ）. The radiation dose was 40 - 60 Gy, 17 - 30 fx, 28 - 45 d （ median： 48 Gy, 24 fx, 35 d ）. The biologically effective dose was calculated using the linear quadratic model. Radiation toxicity and short-term efficacy were recorded. The overall survival rate, relapse-free survival rate, and radiation necrosis free survival rate was calculated. Results： The median biological equivalent dose was 58 Gy （ 48-72 Gy ） in this group. Grades I and II of acute digestive tract side effects, headache and aggravation of neurologic dysfunction, were observed, which were relieved with symptomatic treat- ment. Toxicity of more than grade III was not found. Five cases with radiation necrosis were found. Among the 19 cases, 3 cases had partial remission, 13 cases had stable disease, and 3 cases had progressive disease. Up to 5 cases had increased Karnovsky performance status, 4 cases had declined Karnovsky performance status, and l0 cases hat no change. The 1- and 2-year overall survival rates were 62.4% and 34.0%. The median survival time of the anaplastic gliomas and glioblastomas were 11 and 10 months, respectively. The l - and 2-year relapsed-free survival rates were 45.6% and 26.1%. The 1- and 2-year radiation necrosis-free rates were 68.8% and 55.0%. Conclusion： The preliminary results demonstrate that re-irradiation with IMRT and modest dose （median BEDα/β=10= 58 Gy ） with or without chemotherapy for recurrent HGG appear to be effective and safe. With the limited number of patients in this group, re-irradiation could be used for treating recurrent g

关 键 词：放射治疗 再程放射治疗 高分级胶质瘤 调强适形放射治疗 

分 类 号：R739.4[医药卫生—肿瘤]