Showalter Timothy N, Andrel Jocelyn, Andrews David W, Curran Walter J, Daskalakis Constantine, Werner-Wasik Maria
Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):820-4. doi: 10.1016/j.ijrobp.2007.03.045. Epub 2007 May 17.
To assess the progression patterns in patients with multifocal glioblastoma multiforme who had undergone whole brain radiotherapy (WBRT), the historical standard, versus three-dimensional conformal radiotherapy, and to identify predictive treatment and pretreatment factors.
The records of 50 patients with multifocal glioblastoma multiforme treated with RT were reviewed. Univariate analyses were performed using survival methods and the Cox proportional hazards regression method. Multivariate analyses were performed using the Cox proportional hazards regression method.
The mean age was 61 years, and 71% had a Karnofsky performance status (KPS) score of > or =70. Of the 50 patients, 32% underwent WBRT and 68%, three-dimensional conformal RT. Progression was local in all evaluable patients, as determined by imaging in 38 patients and early neurologic progression in 12. The median time to progression (TTP) was 3.1 months, and the median survival time (MST) was 8.1 months. The significant independent predictors of TTP on multivariate analysis were a KPS score <70 (p = 0.001), the extent of surgery (p = 0.040), a radiation dose <60 Gy (p = 0.027), and the lack of chemotherapy (p = 0.001). The significant independent predictors of a reduced MST were a KPS score <70 (p = 0.022) and the absence of salvage surgery (p = 0.011) and salvage chemotherapy (p = 0.003).
Local progression was observed in all patients. On multivariate analysis, no significant difference was found in the TTP or MST between three-dimensional conformal radiotherapy and WBRT. The KPS was a consistent independent predictor of both TTP and MST. On the basis of the progression pattern, we do not recommend WBRT as a mandatory component of the treatment of multifocal glioblastoma multiforme.
评估接受全脑放疗（WBRT，既往标准治疗）与三维适形放疗的多形性胶质母细胞瘤患者的进展模式，并确定预测性治疗及预处理因素。
回顾了50例接受放疗的多形性胶质母细胞瘤患者的记录。采用生存方法及Cox比例风险回归方法进行单因素分析。采用Cox比例风险回归方法进行多因素分析。
患者平均年龄61岁，71%的患者卡氏功能状态（KPS）评分≥70分。50例患者中，32%接受了WBRT，68%接受了三维适形放疗。根据38例患者的影像学检查及12例患者的早期神经功能进展情况确定，所有可评估患者均出现局部进展。进展的中位时间（TTP）为3.1个月，中位生存时间（MST）为8.1个月。多因素分析显示，TTP的显著独立预测因素包括KPS评分<70分（p = 0.001）、手术范围（p = 0.040）、放疗剂量<60 Gy（p = 0.027）及未进行化疗（p = 0.001）。MST降低的显著独立预测因素包括KPS评分<70分（p = 0.022）、未进行挽救性手术（p = 0.011）及未进行挽救性化疗（p = 0.003）。
所有患者均出现局部进展。多因素分析显示，三维适形放疗与WBRT在TTP或MST方面无显著差异。KPS是TTP和MST一致的独立预测因素。基于进展模式，我们不推荐将WBRT作为多形性胶质母细胞瘤治疗的必需组成部分。
