Department of Radiation Oncology, Konkuk University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2005 Apr;37(2):109-13. doi: 10.4143/crt.2005.37.2.109. Epub 2005 Apr 30.
The outcome and prognostic factors of brainstem glioma were evaluated following radiotherapy methods.
Between 1986 and 2001, 45 childhood patients with diffuse brainstem glioma were treated. There were 26 boys and 19 girls, with a median age of 7 years (range 3 approximately 18). The histopathological diagnoses were confirmed in 13 patients, which revealed a low-grade glioma in four patients, and high-grade glioma in the other nine. Before 1993, radiation therapy using a regime of 1.8 to 2.0 Gy once a day was performed in 16 cases; thereafter, a regimes of 1.1 or 1.5 Gy twice a day was given in 15 and 14 cases, respectively. Nine patients were treated with adjuvant chemotherapy. The response to the treatment was evaluated by the MRI findings 4 weeks after radiotherapy.
After radiotherapy, the neurological deficit improved in 42 of the 45 patients (93%). The MRI responses were as follows; partial response 22/39 (56%), minimal to no response in 16/39 (41%) and tumor progression in 1/39 (3%). The median time to disease progression was 7 months, and the median survival was 12 months; the overall survival rate at 1 year was 41%. There was no significant prognostic factor for overall survival. The progression-free survival was influenced by the tumor histology (low grade vs. high grade, p=0.05) in those patients whose pathology was confirmed.
The radiation therapy fractionation schedule did not influence the survival. Low grade histology was a possible favorable prognostic factor of progression-free survival in pediatric brainstem glioma patients.
评估不同放疗方法治疗脑干胶质瘤的疗效和预后因素。
1986 年至 2001 年间，收治 45 例弥漫性脑干胶质瘤患儿。男 26 例，女 19 例，中位年龄 7 岁（3-18 岁）。13 例经病理证实，其中 4 例为低级别胶质瘤，9 例为高级别胶质瘤。1993 年前，16 例患儿接受 1.8-2.0Gy 单次放疗，此后 15 例和 14 例患儿分别接受 1.1Gy 和 1.5Gy 2 次/d 放疗。9 例患儿接受辅助化疗。放疗 4 周后 MRI 评估疗效。
45 例患儿中，42 例（93%）神经功能缺损改善。MRI 疗效评价：部分缓解 22/39（56%），轻微缓解或无缓解 16/39（41%），肿瘤进展 1/39（3%）。中位疾病进展时间为 7 个月，中位生存时间为 12 个月，1 年总生存率为 41%。总生存无显著预后因素。病理证实的患儿中，肿瘤组织学（低级别 vs. 高级别）是无进展生存的影响因素（p=0.05）。
放疗分割方案不影响生存。组织学分级为低级别是儿童脑干胶质瘤无进展生存的可能有利预后因素。
