Wang Yun-yan, Bao Xiu-feng, Li Shu-ying, Wu Cheng-yuan
Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, P. R. China.
Ai Zheng. 2002 Oct;21(10):1149-53.
BACKGROUND & OBJECTIVE: Though radiosurgery has been used for more than 10 years, the value of radiosurgery for malignant glioma has not been clarified. This paper was designed to investigate efficacy of radiosurgery to malignant glioma by analyzing the prognostic factors affecting prognosis of malignant gliomas treated with linac radiosurgery.
Fifty-eight patients with deep situated malignant gliomas, 28 anaplastic astrocytomas(AA) and 30 glioblastomas (GBM), aged from 7 to 70 years, were analyzed. The mean volume of tumor was 12.08 cm3, and mean prescription dose for linac radiosurgery was 19.42 Gy. The results were analyzed with Kaplan-Meier curve and Cox regression.
There were 44.8% of the tumors shrank. Median tumor local control interval was 10 months(15 months for AA and 9 months for GBM). Tumor local control probability was 37.9% for 1 year and 10.3% for 2 years. Median survival was 22.5 months for AA and 13 months for GBM and 15 months for all patients. The survival probability was 79.3% at 1 year and 20.6% at 2 years. Isocenter numbers and tumor volume were the prognostic factors for tumor control, but conformity index was prognostic factor for survival as determined by Cox regression analysis. Considered of pathology, only isocenter number and target volume significantly affected the tumor control interval. Complication appeared in 44.8% of the patients and the median interval of complication onset was 8 months. Symptomatic cerebral edema was observed in 31.0% of the patients.
Linac radiosurgery can effectively improve tumor local control and elongate survival for the patients with deep situated malignant gliomas. Tumor volume is the prognostic factor for tumor control, while conformity index is prognostic factor for survival.
尽管放射外科已应用超过10年,但放射外科治疗恶性胶质瘤的价值尚未明确。本文旨在通过分析影响直线加速器放射外科治疗恶性胶质瘤预后的因素,探讨放射外科治疗恶性胶质瘤的疗效。
分析58例深部恶性胶质瘤患者,其中28例间变性星形细胞瘤(AA)和30例胶质母细胞瘤(GBM),年龄7至70岁。肿瘤平均体积为12.08 cm³,直线加速器放射外科的平均处方剂量为19.42 Gy。采用Kaplan-Meier曲线和Cox回归分析结果。
44.8%的肿瘤缩小。肿瘤局部控制中位间隔时间为10个月(AA为15个月,GBM为9个月)。1年时肿瘤局部控制概率为37.9%,2年时为10.3%。AA的中位生存期为22.5个月,GBM为13个月,所有患者为15个月。1年生存率为79.3%,2年生存率为20.6%。等中心数量和肿瘤体积是肿瘤控制的预后因素,但Cox回归分析确定适形指数是生存的预后因素。从病理角度考虑,只有等中心数量和靶体积显著影响肿瘤控制间隔。44.8%的患者出现并发症,并发症发生的中位间隔时间为8个月。31.0%的患者出现症状性脑水肿。
直线加速器放射外科可有效提高深部恶性胶质瘤患者的肿瘤局部控制率并延长生存期。肿瘤体积是肿瘤控制的预后因素,而适形指数是生存的预后因素。