Ⅱ级胶质瘤术后调强放射治疗疗效分析  

The efficacy of gradeⅡglioma with postoperative intensity modulated radiotherapy

作　　者：黎珊[1] 王雪真 陈燕彬[1] 吴赞艺[3] 张海荣 曾疆 蔡传书[1] 张纬建[1] 苏丽[1] 洪金省[1] Li Shan;Wang Xuezheng;Chen Yanbin;Wu Zanyi;Zhang Hairong;Zeng Jiang;Cai Chuanshu;Zhang Weijian;Su Li;Hong Jinsheng(Department of Radiation Oncology,First Affiliated Hospital of Fujian Medical University,Fujian Key Laboratory of Individualized Active Immunotherapy,Key Laboratory of Radiation Biology(Fujian Medical University),Fuzhou 350005,China;First Clinical Medical College of Fujian Medical University,Fuzhou 350005,China;Department of Neurosurgery,First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Provincial Center for Disease Control and Prevention,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院放疗科福建省个体化主动免疫治疗重点实验室放射生物福建省高等学校重点实验室,福州350005 [2]福建医科大学第一临床医学院,福州350005 [3]福建医科大学附属第一医院神经外科,福州350005 [4]福建省疾病预防控制中心,福州350005

出　　处：《中华放射医学与防护杂志》2020年第2期112-115,共4页Chinese Journal of Radiological Medicine and Protection

基　　金：福建省卫生厅青年科研基金(2018-01-58);福建医科大学启航基金项目(2018QH1088)的资助。

摘　　要：目的分析Ⅱ级胶质瘤术后调强放射治疗的疗效及预后影响因素。方法对2010年1月至2018年12月期间收治的接受术后调强放射治疗的109例Ⅱ级胶质瘤患者进行回顾性分析。主要研究终点为无复发生存率、次要研究终点为总生存率。分析年龄、性别、手术切除状态、病灶最大径、肿瘤跨中线、含星形细胞瘤成份、同步放化疗、辅助化疗等因素对无复发生存的影响。结果全组随访率91.75%,随访期间10例死亡,27例复发。照射野内复发24例,占88.9%;照射野外复发3例,占11.1%。其中,肿瘤全切组81例复发14例,占17.3%;部分切除组28例复发13例,占46.4%。部分切除组复发率明显高于全切组(χ^2=9.484,P<0.05)。全组患者1、2、3、4、5年无复发生存率分别为92.5%、86.0%、80.6%、77.5%、66.8%,2、3、4、5年总生存率分别为97.2%、90.8%、87.7%、84.5%。多因素分析显示,手术部分切除(HR=3.608,P<0.05)、肿瘤跨中线(HR=3.183,P<0.05)患者更容易复发进展。结论Ⅱ级胶质瘤行术后调强放射治疗,可获得较好的无复发生存。照射野内复发为主要的治疗失败模式,手术切除状态、肿瘤是否跨中线是影响无复发生存的重要因素。Objective To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for gradeⅡgliomas.Methods Retrospective analysis was conducted on patients with postoperative gradeⅡglioma in our hospital from Jan.2010 to Dec.2018.The primary endpoint was progression-free survival,and the secondary endpoint was overall survival.Correlative analyses of prognosis by age,gender,initial resection status,the maximum diameter of the lesions,bihemisphere,astrocytoma,chemoradiation,adjuvant chemotherapy were conducted.Results A total of 109 cases with gradeⅡglioma were enrolled.The follow-up rate was 91.75%,including 10 cases dead and 27 relapsed.There were 24 cases(88.9%)of in-field failure,and 3 cases(11.1%)of out-field failure.14 cases of recurrence occurred in 81 cases of total resection group,accounting for 17.3%,and 13 in 28 cases of subtotal resection group,accounting for 46.4%.The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group(χ^2=9.484,P<0.05).The 1-,2-,3-,4-and 5-year progression-free survival rates were 92.5%,86.0%,80.6%,77.5%and 66.8%,respectively.The 2-,3-,4-and 5-year overall survival rates were 97.2%,90.8%,87.7%and 84.5%,respectively.Multivariate analysis showed that patients with subtotal resection(HR=3.608,P<0.05)and bi-hemisphere(HR=3.183,P<0.05)were significantly correlated with the progression free survival.Conclusions Postoperative intensity modulated radiotherapy for gradeⅡgliomas can achieve a better PFS.Recurrence in the radiation field is the main failure mode.Initial resection status and bihemisphere of tumor are important influential factors for PFS of gradeⅡgliomas patients.

关 键 词：Ⅱ级胶质瘤 调强放射治疗 疗效 预后 

分 类 号：R73[医药卫生—肿瘤]