脑胶质母细胞瘤术后照射缩小靶区放疗方案的疗效  

Efficacy of postoperative radiotherapy with reduced target volume in patients with glioblastoma multiforme

作　　者：郦守国[1] 郭群煌 郭瑞祥[1] LI Shouguo;GUO Qunhuang;GUO Ruixiang(Department of Tumor Radiotherapy,Zhongshan Hospital,Xiamen University,Xiamen 361004 China)

机构地区：[1]厦门大学附属中山医院肿瘤放疗科,福建厦门361004

出　　处：《中国辐射卫生》2022年第6期746-749,755,共5页Chinese Journal of Radiological Health

摘　　要：目的探索脑胶质母细胞瘤术后照射缩小靶区放疗方案的疗效,为制定脑胶质母细胞瘤术后放疗方案提供参考依据。方法回顾性分析29例采用缩小靶区方案初治的脑胶质母细胞瘤术后辅助放化疗患者病历资料,肿瘤靶区(GTV)包括术后瘤腔和残留灶,临床靶区(CTV)为GTV外扩2.5 cm根据危及器官和解剖结构适当修正后的区域,对GTV和CTV的计划靶区采用调强放射治疗同步加量照射60 Gy/30次和54 Gy/30次,分析无进展生存期(PFS)和复发部位。结果29例胶质母细胞瘤患者中,3例无复发生存,无复发生存期分别为52、20、19个月。26例复发胶质母细胞瘤患者中,无CTV内复发;25例GTV内复发,其中3例同时伴颅内播散;另1例仅表现为颅内播散无GTV内复发,中位PFS为7个月(4~15个月)。3例GTV内复发同时伴颅内播散的胶质母细胞瘤患者中,1例原发灶在右额顶叶、转移灶在右枕叶,1例原发灶在右枕叶、转移灶在小脑多发,1例原发灶在左额叶、转移灶在右额叶。行部分切除术的7例胶质母细胞瘤患者PFS为4~5个月,行全切除术和次全切除术者PFS为6~15个月,3例无复发生存者均行全切除术。结论缩小脑胶质母细胞瘤术后照射范围患者仍以靶区内复发为主要模式,60 Gy/30次剂量不足以控制胶质母细胞瘤瘤腔和残留病灶。Objective To evaluate the therapeutic efficacy of radiotherapy with reduced target volume in glioblastoma multiforme patients following surgical treatment,and to provide a basis for the development of postoperative radiotherapy regimens for glioblastoma multiforme.Methods The medical records of 29 patients with glioblastoma multiforme receiving postoperative adjuvant radiochemotherapy with a reduced radiation target were retrospectively reviewed.The gross tumor volume(GTV)included postoperative tumor cavity and residual lesions,and the clinical target volume(CTV)was GTV plus 2.5 cm margin with adaptation according to the affected organs and anatomic structures.GTV and CTV received intensity-modulated radiotherapy with concomitant boost at 60 Gy/30 fractions and 54 Gy/30 fractions,respectively.The progression-free survival(PFS)and site of recurrence were analyzed.Results The patients were followed up until March 2022.Among the 29 patients with glioblastoma multiforme,3 showed recurrence-free survival of 52,20,and 19 months,respectively.Among the 26 patients with recurrent glioblastoma multiforme,there were no case with recurrence in CTV,25 cases with recurrence in GTV(including 3 cases with intracranial dissemination),and one case with intracranial dissemination and without recurrence in GTV.The median PFS was 7 months(4 to 15 months).Among the 3 patients with recurrence in GTV and intracranial dissemination,one showed primary lesion in the right frontal parietal lobe and the metastatic lesion in the right occipital lobe,one primary lesion in the right occipital lobe and multiple metastatic lesions in the cerebellum,and one primary lesion in the left frontal lobe and the metastatic lesion in the right frontal lobe.The PFS was 4 to 5 months for seven patients receiving partial resection,and 6 to 15 months for patients receiving total and subtotal resection.The three recurrence-free survivors all underwent total resection.Conclusion Recurrence in target volume still prevails in patients with glioblastoma multiforme

关 键 词：胶质母细胞瘤 放射治疗 照射靶区 治疗效果 

分 类 号：R816[医药卫生—放射医学]