术后放疗在神经节细胞瘤治疗中的作用。

The role of postoperative radiotherapy for the treatment of gangliogliomas.

机构信息

Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany.

出版信息

Cancer. 2010 Jan 15;116(2):432-42. doi: 10.1002/cncr.24716.

DOI:10.1002/cncr.24716

PMID:19908258

Abstract

BACKGROUND

Because of their rarity, no prospective studies have been performed regarding gangliogliomas. The optimal treatment regimen is unclear. In this study, the authors compared 4 therapies for local control (LC) and overall survival (OS) in patients with ganglioglioma.

METHODS

In 402 patients with ganglioglioma, outcomes were compared for patients who underwent gross total resection alone (GTR) (n = 188), GTR plus radiotherapy (GTR + RT) (n = 21), subtotal resection alone (STR) (n = 113), and STR plus RT (STR + RT (n = 80). Age, sex, tumor site, and histologic grade also were investigated. Subgroup analyses were performed for both low-grade and high-grade tumors.

RESULTS

The 10-year LC rates were 89% after GTR, 90% after GTR + RT, 52% after STR, and 65% after STR + RT (P < .001); and the 10-year OS rates were 95%, 95%, 62%, and 74%, respectively (P < .001). After STR, irradiation significantly improved LC (P = .004) but not OS (P = .22). After GTR, irradiation did not significantly improve LC (P = .23) or OS (P = .29). On multivariate analyses, LC and OS were associated with therapy and pathologic grade, and OS also was associated with tumor site. In low-grade tumors, STR + RT resulted in better LC (P = .016) but not better OS (P = .18); and, after GTR, LC (P = .28) and OS (P = 1.0) were not improved with postoperative radiotherapy. In high-grade tumors, STR + RT resulted in better LC (P = .016) but not better OS (P = .41); after GTR, LC (P = .56) and OS (P = .61) were not improved with irradiation.

CONCLUSIONS

According to this review, GTR should be performed whenever safely possible and does not require postoperative irradiation. If only STR is achieved, then RT improves LC of both low-grade and high-grade tumors and, thus, should be considered seriously.

摘要

背景

由于其罕见性，尚未进行关于神经节细胞瘤的前瞻性研究。最佳治疗方案尚不清楚。在这项研究中，作者比较了 4 种局部控制（LC）和总生存（OS）治疗方案在神经节细胞瘤患者中的疗效。

方法

在 402 例神经节细胞瘤患者中，对接受单纯大体全切除（GTR）（n=188）、GTR 加放疗（GTR+RT）（n=21）、单纯次全切除（STR）（n=113）和 STR 加放疗（STR+RT）（n=80）的患者进行了结局比较。还研究了患者的年龄、性别、肿瘤部位和组织学分级。对低级别和高级别肿瘤分别进行了亚组分析。

结果

GTR 后 10 年 LC 率为 89%，GTR+RT 后为 90%，STR 后为 52%，STR+RT 后为 65%（P<0.001）；10 年 OS 率分别为 95%、95%、62%和 74%（P<0.001）。STR 后，放疗显著提高了 LC（P=0.004），但未提高 OS（P=0.22）。GTR 后，放疗对 LC（P=0.23）和 OS（P=0.29）的改善均无显著影响。多因素分析显示，LC 和 OS 与治疗和病理分级相关，OS 还与肿瘤部位相关。在低级别肿瘤中，STR+RT 可提高 LC（P=0.016），但不提高 OS（P=0.18）；GTR 后，术后放疗对 LC（P=0.28）和 OS（P=1.0）均无改善。在高级别肿瘤中，STR+RT 可提高 LC（P=0.016），但不提高 OS（P=0.41）；GTR 后，放疗对 LC（P=0.56）和 OS（P=0.61）均无改善。