Objective: To evaluate the outcome and prognostic factors of simultaneous integrated boost intensity-modulated radiotherapy(SIB-IMRT)in the treatment of malignant gliomas. Methods: From Apr.2009 to Apr.2012, 94 cases of malignant glioma were treated with SIB-IMRT. All patients fixed with mask and had a CT scan. The target volumes(CTV,CTV)and organs at risk(OAR)were contoured. GTV was identified as residual focus after partial or near total resection, CTV as the preoperation focus with 2.0 cm margin. The doses of prescription were GTV 60 Gy, 2.4 Gy·f-1, CTV 50 Gy, 2.0 Gy·f-1 using SIB technique and IMRT was implemented with MIMIC system. The treatment reaction was recorded. The overall survival rate was calculated. The prognostic factors were analyzed by using multivariate COX regression model. Results: The acute treatment toxicity occurred mostly in grade 1 to grade 2 and no adverse reaction was observed in grade 4. Two cases had late radiation induced brain necrosis. The overall 1-, 2-, and 3-year survival rates were 81.1%, 57.1% and 30.7%, and the 1-year, 2-yera, and 3-year local progression free survival rate were 65.3%, 40.0% and 11.8%. Multivariate analysis revealed that tumor location, pathological grading and extent of resection were independent prognostic factors. Conclusion: Postoperative SIB-IMRT has a 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. |
[1] 《中国中枢神经系统胶质瘤诊断和治疗指南》编写组.中国中枢神经系统胶质瘤诊断和治疗指南(2012)[J].中华医学杂志,2013,93(31):2418-2449.
[2] 高翔.颅脑肿瘤治疗趋势[J].现代实用医学,2012,24(10):1084-1087.
[3] CHEN A M,FARWELL D G,LUU Q,et al.Intensity-modulated radiothera-PY is associated with improved global quality of life among long-term survivors of head and-neck cancer[J].Int J Radiat Oncol Biol Phys,2012,84(1):170-175.
[4] CHO K H,KIM P I T,LEE S H,et al.Simultaneous integrated boost intensity- modulated radiotherapy in patients with high-grade gliomas[J].Int J Radiat Oncol Biol Phys,2010,78(2):390-397.
[5] 殷蔚伯,谷铣之,陈东福.肿瘤放射治疗学[M].北京:中国协和医科大学出版社,2002:1109-1110.
[6] CAO J Q,FISHER B J,BAUMAN G S,et al.Hypofractionated radiotherapy with or without concurrent temozolomide in elderly patients with glioblastoma multiforme:a review of ten-year single institutional experience[J].J Neurooncol,2012,107(2):395-405.
[7] 蒋静,房彤,陈怡东,等.影响脑干胶质瘤放射治疗预后的相关因素分析[J].中华神经外科杂志,2013,29(11):1093-1096.
[8] PANET-RAYMOND V,SOUHAMI L,ROBERGE D,et al.Accelerated hypofractionated intensity-modulated radiotherapy with concurrent and adjuvant temozolomide for patients with glioblastoma multiforme:a safety and efficacy analysis[J].Int J Radiat Oncot Biol Phys,2009,73(2):473-478.
[9] 何少忠,孙新臣,肖震宇,等.高分级脑胶质瘤同步加量调强放射治疗的疗效与剂量分析[J].中国临床研究,2013,26(9):900-902.
[10] 段伟,刘宁宁,高娜,等.老年食管癌三维适形放疗与调强放疗同步奈达铂化疗疗效观察[J].现代医学,2105,43(2):187-190.
[11] MCCREA H J,BANDER E D,VENN R A,et al.Sex,age,anatomic location,and extent of resection influence outcomes in children with high-grade glioma[J].Neurosurgery,2015,77(3):443-452.
[12] LOMBARDI G,PACE A,PASQULETTI F,et al.Predictors of survival and effect of short(40 Gy)or standard-course(60 Gy)irradiation plus concomitant temozolomide in elderly patients with glioblastoma:a multicenter retrospective study of AINO(Italian Association of Neuro-Oncology)[J].Neurosurgery,2015,125(2):359-367.
[13] 汪洋,盛晓芳,高晶,等.高分级神经胶质瘤112例术后放、化疗疗效及其预后分析[J].肿瘤,2009,29(7):668-672.
[14] 林清,金冶宁,吴国华,等.恶性脑胶质瘤的化疗以及与放疗的相互作用[J].中国肿瘤临床与康复,2007,14(6):560-562. |