Nieder C, Nestle U, Ketter R, Kolles H, Gentner S J, Steudel W I, Schnabel K
Department of Radiotherapy, University Hospital of Saarland, Homburg/Saar, Germany.
Radiat Oncol Investig. 1999;7(1):36-41. doi: 10.1002/(SICI)1520-6823(1999)7:1<36::AID-ROI5>3.0.CO;2-O.
Because of promising radiobiological advantages allowing dose escalation and/or reduction of treatment time, hyperfractionated and accelerated-hyperfractionated radiotherapy (hf-rt, ahf-rt) were introduced as part of treatment of glioblastoma multiforme (gbm). In December 1988 we started a prospective study of hf-rt (total dose 78 Gy, two daily fractions of 1.3 Gy, interval between daily fractions 6 hr, treatment time 6 weeks, n = 34 patients). The results were compared with our previous regimen of conventionally fractionated radiotherapy (cf-rt: total dose 60 Gy, single dose 2 Gy, treatment time 6 weeks, n = 32 patients). In June 1990, the protocol was modified in order to reduce treatment time (ahf-rt: total dose 60 Gy, two daily fractions of 1.5 Gy, interval 6 hr, treatment time 4 weeks, n = 92 patients until December 1996). No chemotherapy was given. Entry criteria were: age > or = 17 years, pathological diagnosis of supratentorial gbm, and no previous treatment other than surgery. The ahf-rt group included significantly more patients with previous surgical resection instead of biopsy only. Compared with the cf-rt group, both the hf-rt and the ahf-rt group included significantly more patients with frontal tumor location. We found no significant survival difference between the groups (median survival 7-10 months, 1-year survival rate 19%-29%). Progression-free survival, clinical course, and toxicity were also not significantly different. Karnofsky performance status, age, and corticosteroid dose during radiotherapy were the most important prognostic factors. The results of this trial are in large agreement with most previous publications. It demonstrated no improved survival. However, it showed that treatment time can be reduced by ahf-rt without loss of survival benefit or intolerable toxicity. A short radiotherapy course might be appropriate for many patients with gbm who are not suitable for rather aggressive investigational therapies.
由于超分割和加速超分割放疗（hf-rt，ahf-rt）具有良好的放射生物学优势，可实现剂量递增和/或缩短治疗时间，因此被引入多形性胶质母细胞瘤（gbm）的治疗方案中。1988年12月，我们开展了一项hf-rt前瞻性研究（总剂量78 Gy，每日两次，每次1.3 Gy，两次分割间隔6小时，治疗时间6周，n = 34例患者）。将结果与我们之前的常规分割放疗方案（cf-rt：总剂量60 Gy，单次剂量2 Gy，治疗时间6周，n = 32例患者）进行比较。1990年6月，对方案进行了修改以缩短治疗时间（ahf-rt：总剂量60 Gy，每日两次，每次1.5 Gy，间隔6小时，治疗时间4周，截至1996年12月n = 92例患者）。未给予化疗。入选标准为：年龄≥17岁，幕上gbm病理诊断，且除手术外无既往治疗史。ahf-rt组中既往接受手术切除而非仅活检的患者明显更多。与cf-rt组相比，hf-rt组和ahf-rt组中肿瘤位于额叶的患者明显更多。我们发现两组之间的生存差异无统计学意义（中位生存期7 - 10个月，1年生存率19% - 29%）。无进展生存期、临床病程和毒性也无显著差异。放疗期间的卡诺夫斯基功能状态、年龄和皮质类固醇剂量是最重要的预后因素。该试验结果与大多数既往发表的研究结果高度一致。它并未显示出生存率的改善。然而，它表明ahf-rt可缩短治疗时间，且不损失生存获益或产生无法耐受的毒性。对于许多不适合进行激进研究性治疗的gbm患者，短疗程放疗可能是合适的。
