Voynov George, Kaufman Seth, Hong Theodore, Pinkerton Arthur, Simon Richard, Dowsett Robert
Department of Radiation Oncology, University of Connecticut Health Center, Farmington, Connecticut 06030-2930, USA.
Am J Clin Oncol. 2002 Dec;25(6):606-11. doi: 10.1097/00000421-200212000-00017.
Malignant gliomas are usually refractory to aggressive combined-modality therapy, and the incidence of recurrence and death after treatment is very high. State-of-the-art techniques such as stereotactic intensity-modulated radiation therapy (IMRT) are now available to deliver a high dose of radiation to the tumor with relative preservation of surrounding tissues to achieve optimal tumor coverage with minimal toxicity. We report 10 patients (median age 48 years) with recurrent malignant gliomas that were treated with stereotactic directed IMRT. Initial tumor histologies included one low grade glioma (upgraded to anaplastic astrocytoma at recurrence), four anaplastic astrocytomas, and four glioblastomas multiforme. One patient was originally presumed to have a brain metastasis secondary to renal cell carcinoma but was pathologically confirmed as having glioblastoma multiforme at the time of recurrence. Before recurrence, all patients had been treated with external beam radiation therapy (median 59.7 Gy). All recurrences were confirmed by a subtotal resection (5/10) or by imaging (5/10). The median Karnofsky performance score at the time of IMRT was 80. The median tumor volume was 34.69 cm. Treatment was delivered on a 10-MV linear accelerator with a mini-multileaf collimator, MIMiC, and planned with Peacock/Corvus software. Radiation was delivered in daily fractions of 5 Gy, to a total median dose of 30 Gy at the 71% to 93% median isodose line. Median overall survival time was 10.1 months from the date of stereotactic treatment, with 1- and 2-year survival rates of 50% and 33.3%, respectively. Fractionated stereotactic intensity modulated radiation therapy is a novel technique used in the treatment of recurrent malignant gliomas, which produces results comparable to other currently used stereotactic techniques.
恶性胶质瘤通常对积极的综合治疗方法具有耐药性，治疗后的复发率和死亡率非常高。现在已有诸如立体定向调强放射治疗（IMRT）等先进技术，可在相对保留周围组织的情况下向肿瘤输送高剂量辐射，以实现最佳肿瘤覆盖并将毒性降至最低。我们报告了10例复发性恶性胶质瘤患者（中位年龄48岁），他们接受了立体定向IMRT治疗。初始肿瘤组织学类型包括1例低级别胶质瘤（复发时升级为间变性星形细胞瘤）、4例间变性星形细胞瘤和4例多形性胶质母细胞瘤。1例患者最初被推测为肾细胞癌继发脑转移，但在复发时经病理证实为多形性胶质母细胞瘤。复发前，所有患者均接受了外照射放疗（中位剂量59.7 Gy）。所有复发均通过次全切除（5/10）或影像学检查（5/10）得到证实。IMRT治疗时的中位卡诺夫斯基功能状态评分是80分。中位肿瘤体积为34.69 cm³。治疗在配备微型多叶准直器MIMiC的10兆伏直线加速器上进行，并使用Peacock/Corvus软件进行计划。放射剂量为每日5 Gy，在71%至93%的中位等剂量线上总中位剂量为30 Gy。从立体定向治疗之日起，中位总生存时间为10.1个月，1年和2年生存率分别为50%和33.3%。分次立体定向调强放射治疗是一种用于治疗复发性恶性胶质瘤的新技术，其产生的结果与目前使用的其他立体定向技术相当。
