Baumert Brigitta G, Lutterbach Johannes, Bernays René, Davis J Bernard, Heppner Frank L
Radiation-Oncology, University Hospital Zurich, Zurich, Switzerland.
Radiother Oncol. 2003 May;67(2):183-90. doi: 10.1016/s0167-8140(02)00386-9.
To determine the value and the toxicity of an additional fractionated stereotactic boost as used in the joint randomized EORTC-22972/MRC-BR10 study in patients with malignant gliomas.
Seventeen patients (11 male, six female) with a high-grade glioma (two WHO III, 15 WHO IV) < or =4 cm in maximum diameter, with a good performance status (WHO > or =2), were treated with a fractionated stereotactic radiotherapy (SRT) boost to 20 Gy in four fractions following partial brain irradiation to a dose of 60 Gy in 30 fractions. This patient group was compared with historical data in a matched-pair analysis.
All patients were treated by conventional radiotherapy and a SRT boost (15 patients received 20 Gy and two patients 10 Gy). Acute side effects included fatigue (two), impairment of short-term memory (one) and worsening of pre-existing symptoms (one). No patient developed steroid dependence after SRT. One patient was re-operated for radiation necrosis. At a median follow-up of 25 months (9-50 months) 14 patients recurred locally. Survival was 77% at 1 year and 42% at 2 years; progression-free survival was 70% at 1 year and 35% at 2 years for all patients, respectively. Median survival for the whole patient group is 20 months. Comparison with a matched historical group showed a significantly better survival for the group treated with a stereotactic boost (P<0.0001).
A fractionated stereotactic boost after standard external beam radiotherapy in selected patients with high-grade glioma is feasible and well tolerated with low toxicity. Compared to historical data survival is significantly better with an additional SRT boost. However, its effectiveness has to be proven in a randomized trial.
确定在欧洲癌症研究与治疗组织（EORTC）-22972/英国医学研究理事会（MRC）-BR10联合随机研究中用于恶性胶质瘤患者的额外分次立体定向放疗增敏的价值和毒性。
17例患者（11例男性，6例女性）患有高级别胶质瘤（2例世界卫生组织（WHO）III级，15例WHO IV级），最大直径≤4 cm，身体状况良好（WHO≥2级），在全脑照射30次剂量达60 Gy后，接受分次立体定向放射治疗（SRT）增敏，分4次给予20 Gy。该患者组与历史数据进行配对分析比较。
所有患者均接受了常规放疗和SRT增敏（15例患者接受20 Gy，2例患者接受10 Gy）。急性副作用包括疲劳（2例）、短期记忆损害（1例）和原有症状加重（1例）。SRT后无患者出现类固醇依赖。1例患者因放射性坏死接受再次手术。中位随访25个月（9 - 50个月）时，14例患者出现局部复发。所有患者1年生存率为77%，2年生存率为42%；无进展生存率1年时为70%，2年时为35%。整个患者组的中位生存期为20个月。与配对的历史组比较显示，接受立体定向增敏治疗的组生存率显著更高（P<0.0001）。
在部分选定的高级别胶质瘤患者中，标准外照射放疗后进行分次立体定向增敏是可行的，耐受性良好，毒性低。与历史数据相比，额外的SRT增敏可显著提高生存率。然而，其有效性必须在随机试验中得到证实。
