基于磁共振指导靶区勾画的高级别胶质瘤术后调强放射治疗的疗效分析  

The efficacy of high-grade glioma postoperative IMRT based on MRI-guiding target delineation

作　　者：黎珊[1] 张纬建[1] 蔡传书[1] 陈君 张海荣 洪金省[1] 

机构地区：[1]福建医科大学附属第一医院放疗科放射生物福建省高等学校重点实验室福建省神经医学研究中心,福州350004 [2]江西省九江市第三人民医院放疗科,九江332000 [3]福建省疾病预防控制中心免疫规划所,福州350004

出　　处：《中华放射医学与防护杂志》2017年第10期767-770,共4页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 回顾性分析基于磁共振（MRI）指导靶区勾画的高级别胶质瘤术后行调强放射治疗联合替莫唑胺化疗的疗效及预后影响因素.方法 回顾性分析本院放疗科2010年10月至2015年12月收治的111例高级别胶质瘤术后患者.通过MRI-CT融合技术,在手术前、术后（〈72 h）及放疗前,MRI指导下勾画靶区,行调强放射治疗联合替莫唑胺化疗.用K-M法计算生存率,分别采用Log-Rank检验和COX回归分析进行单因素和多因素统计分析,分析患者的年龄、性别、病理分级、病灶数量、是否累及多个脑叶、是否跨中线、伴有癫痫发作、病灶最大径、辅助化疗等因素对预后的影响.结果 全组111例符合入组条件的患者随访率为94.6%.全组患者1、2、3、4、5年生存率分别为81.6%、54.2%、39.1%、25.4%、15.5%,中位生存期为38个月.单因素分析结果显示,病理分级、年龄、术前肿瘤最大径、辅助化疗对生存率有影响（χ^2=5.549、6.393、4.555、4.965,P〈0.05）;多因素分析提示,病理低分级、年轻、术前肿瘤最大径较小有较好预后（Wald=4.784、4.560、5.859,P〈0.05）.结论 高级别胶质瘤术后,通过MRI-CT融合技术,在术前、术后（〈72 h）及放疗前MRI指导下制定放疗靶区,行调强放射治疗联合替莫唑胺化疗,可取得较好疗效,其中Ⅲ级胶质瘤、〈50岁、肿瘤最大径〈6 cm、接受辅助化疗者预后较好.Objective To analyze the efficacy and prognostic factors of postoperative radiotherapy for high grade gliomas based on MRI guided target delineation. Methods Retrospective analysis was conducted on 111 patients with high-grade gliomas from October 2010 to December 2015. The patients were treated with IMRT in combination with temozolomide guided by MRI-CT fusion technique after target delineation at preoperation, postoperation （ 〈 72 h ） and before radiotherapy. The survival rate was calculated by K-M method. The analyses of single factor and multiple factor, ranging from the patients′age, gender, pathological grade, number of lesions, multiple lobes, tumour crossing the midline,epilepsy, the maximum diameter of the lesions, adjuvant chemotherapy and other factors on prognosis were conducted with Log-Rank test and COX regression analysis. Results A total of 111 patients met the criteria for admission, and the overall follow-up rate was 94. 6%. The survival rates of 1-, 2-, 3-, 4-, 5- year were 81. 6%, 54. 2%, 39. 1%, 25. 4%, 15. 5%, respectively. The median survival time was 38 months. The single factor analysis showed that pathological grading （χ2 =5. 549, P〈0. 05）, age （χ2 =6. 393, P〈0. 05）, preoperative tumor maximum diameter （χ2 =4. 555, P〈0. 05） and adjuvant chemotherapy （χ2 =4. 965, P 〈0. 05 ） were correlated with on the survival rate, while multivariate analysis showed that pathological grade Ⅲ, younger age, preoperative tumor with size smaller contributed to the good prognosis （Wald=4. 784, 4. 560, 5. 859, P〈0. 05）. Conclusions High grade gliomas after operation by MRI-CT fusion technique in preoperative and postoperative 72 h and MRI before radiotherapy guided by radiotherapy, for intensity-modulated radiotherapy combined with temozolomide chemotherapy, can obtain better efficacy. The grade Ⅲ of glioma, 〈50 years old, the maximum diameter of the tumor 〈6 cm, the adjuvant chemotherapy may have the better prognosis.

关 键 词：高级别胶质瘤 MRI 调强放疗 疗效 预后因素 

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