恶性胶质瘤患者术后同期推量调强放疗的疗效及预后因素分析  

Analysis of the curative effect and prognostic factors of the patients with malignant glioma after surgery with simultaneous integrated boost intensity modulated radiotherapy

作　　者：陈思群[1] 柳先锋[1] 舒小镭[1] 

机构地区：[1]重庆市肿瘤研究所放疗科,重庆400030

出　　处：《中国肿瘤临床与康复》2016年第8期959-962,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨恶性胶质瘤术后行同期推量调强放疗（SIB-IMRT）的疗效及其预后因素。方法回顾性分析2009年4月至2012年4月间在重庆市肿瘤研究所接受SIB-IMRT治疗的94例恶性胶质瘤术后患者的临床资料,所有患者行计算机断层扫描（CT）定位以确定靶体积[肿瘤体积（GTV）和临床靶区（CTV）]和紧要器官。采用SIB-IMRT,设置处方剂量GTV为60 Gy,每次分割2.4 Gy;CTV为50 Gy,每次分割2 Gy,采用MIMIC系统实施调强放疗。记录放疗期间患者的不良反应,并计算患者的总体生存率和无局部进展生存率。应用Cox回归模型进行预后相关因素的多因素分析。结果 94例患者急性不良反应多为1～2级,无4级以上不良反应。发生后期放射性脑坏死2例。患者的1、2和3年总生存率分别为81.1%、57.1%和30.7%,1、2和3年无局部进展生存率分别为65.3%、40.0%和11.8%。多因素分析显示,影响患者总体生存率和无局部进展生存率的独立预后因素与肿瘤生长位置是否位于功能区（P=0.033、0.021）、病理分级（P=0.019、0.016）、肿瘤切除程度有关（P〈0.001）。结论神经胶质瘤患者术后采用SIB-IMRT治疗可以取得比较满意的近期临床效果,而且放疗不良反应可以耐受。肿瘤是否位于功能区、病理分级和肿瘤手术切除程度为重要的预后因素。Objective To analyze the curative effect and prognostic factors of the patients with malignant glioma after surgery with simultaneous integrated boost intensity modulated radiotherapy,SIB-IMRT） in the treatment of malignant gliomas. Methods From April 2009 to April 2012 in Chongqing Cancer Institute,94 cases of malignant glioma were treated with SIB-IMRT. All patients underwent computed tomography（ CT） to determine the target volume [gross tumor volume（ GTV）,clinical target area（ CTV） ]and organs at risk（ OAR）. Using SIB-IMRT,set the prescription dose of GTV for 60 Gy,2. 4 Gy for each partition,CTV for 50 Gy,2 Gy for each segmentation. Adverse reactions were recorded during radiotherapy,and the overall survival rate and progression-free survival rate were calculated. Multivariate analysis of prognostic factors using Cox regression model. Results The patients in this group had no more than 4 levels of acute adverse reactions,mostly from 1 to 2. There were 2 cases of late radiation brain necrosis. The 1,2and 3 year overall survival rates were 81. 1%,57. 1%,30. 7%,respectively. The progression free survival rates were 65. 3%,40% and 11. 8%,respectively. Multivariate analysis showed that independent prognostic factors of overall survival and local progression-free survival rate were whether the tumor was located in functional area（ P = 0. 033,0. 021）,histological grade（ P = 0. 019,0. 016） and tumor resection extent（ P〈0. 001）. Conclusion Postoperative SIB-IMRT has better short-term efficacy in the treatment of malignant glioma and the adverse reaction is tolerable. Tumor location,pathological grading and extent of resection are important prognostic factors.

关 键 词：神经胶质瘤 同期推量调强放疗 治疗结果 预后 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]