McAleese J J, Stenning S P, Ashley S, Traish D, Hines F, Sardell S, Guerrero D, Brada Michael
Neuro-Oncology Unit and Academic Unit of Radiotherapy and Oncology, The Institute of Cancer Research and The Royal Marsden NHS Trust, London, UK.
Radiother Oncol. 2003 May;67(2):177-82. doi: 10.1016/s0167-8140(03)00077-x.
To assess the survival benefit of palliative hypofractionated radiotherapy in patients with poor prognosis high grade glioma by a matched comparison to conventionally treated controls.
Ninety-two elderly and/or disabled patients with high grade glioma with poor prognostic features received palliative partial brain radiotherapy to a dose of 30Gy in six fractions over 2 weeks. Patients were matched for WHO histological grade, performance status and age from a cohort of patients treated with conventionally fractionated radiotherapy to a dose of 60Gy in 30 fractions in an Medical Research Council (MRC) BR05 trial.
Patients treated with hypofractionated radiotherapy had a median survival of 5 months with a 1-year survival rate of 12% from diagnosis. The median survival of case-matched controls was estimated to be 2.5-4.5 months longer. Following hypofractionated radiotherapy, Barthel score was improved or remained stable in 68% of patients.
Hypofractionated partial brain radiotherapy is a well-tolerated regimen with palliative benefit. Comparison with matched controls suggests lesser survival benefit than would be obtained with radical radiotherapy. However, this is compensated by lower intensity and duration of irradiation induced side effects. It is postulated that there may not be a significant difference in good quality survival or 'quality adjusted survival' between the two regimens and this requires testing in prospective trials.
通过与传统治疗的对照组进行匹配比较，评估姑息性大分割放疗对预后不良的高级别胶质瘤患者的生存获益。
92例具有不良预后特征的老年和/或残疾高级别胶质瘤患者接受了姑息性部分脑放疗，剂量为30Gy，分6次，在2周内完成。从医学研究委员会（MRC）BR05试验中接受传统分割放疗、剂量为60Gy、分30次的患者队列中，根据世界卫生组织组织学分级、体能状态和年龄对患者进行匹配。
接受大分割放疗的患者中位生存期为5个月，从诊断开始的1年生存率为12%。病例匹配对照组的中位生存期估计长2.5 - 4.5个月。大分割放疗后，68%的患者巴氏指数评分得到改善或保持稳定。
大分割部分脑放疗是一种耐受性良好的姑息性治疗方案。与匹配对照组相比，其生存获益比根治性放疗要小。然而，放疗引起的副作用强度和持续时间较低弥补了这一点。据推测，两种治疗方案在良好质量生存或“质量调整生存”方面可能没有显著差异，这需要在前瞻性试验中进行验证。
