成人毛细胞型星形细胞瘤的直接观察与放疗。

Upfront observation versus radiation for adult pilocytic astrocytoma.

机构信息

Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.

出版信息

Cancer. 2011 Sep 1;117(17):4070-9. doi: 10.1002/cncr.25988. Epub 2011 Mar 9.

DOI:10.1002/cncr.25988

PMID:21391213

Abstract

BACKGROUND

Although pilocytic astrocytoma accounts for up to 40% of all childhood brain tumors, it is a rare disease in adults. Consequently, there are few mature data on the impact of up-front treatment options after surgery that include observation or adjuvant radiotherapy.

METHODS

Ten women and 20 men were identified who were diagnosed with pilocytic astrocytoma from 1971 to 2007 and were retrospectively reviewed. The median patient age was 30 years (range, 18-64 years), and the median follow-up was 87 months (range, 16-420 months). Initial surgery included biopsy (10% of patients), subtotal resection (57% of patients), or gross-total resection (33% of patients). Nineteen patients were observed postoperatively, whereas 11 patients received up-front postoperative adjuvant radiotherapy (50 grays in 25 fractions). No patient received adjuvant or concurrent chemotherapy. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Differences between survival curves were analyzed with the log-rank test.

RESULTS

For the entire cohort, the 5-year and 10-year OS rates were 95% and 85%, respectively, and the 5-year and 10-year PFS rates were 63% and 35%, respectively. The median PFS was 8.4 years. Initial radiation, compared with observation, did not have an impact on OS but significantly improved PFS. The 5-year PFS rate for patients who were observed versus those who received radiation was 42% versus 91%, respectively; and, at 10 years, the PFS rate was 17% versus 60%, respectively (P = .005). Patients who progressed after observation (11 of 19 patients) received various salvage therapies, resulting in a 2-year PFS rate of 68% compared with 33% for patients who progressed after initial radiation (3 of 11 patients) and were salvaged with either chemotherapy or surgery (P = .1).

CONCLUSIONS

Adjuvant radiotherapy for pilocytic astrocytoma significantly prolonged PFS at both 5 years and 10 years compared with observation. However, equivalent OS was observed, which reflected the efficacy of salvage therapies.

摘要

背景

尽管毛细胞型星形细胞瘤占所有儿童脑肿瘤的 40%，但在成人中较为罕见。因此，关于包括观察或辅助放疗在内的手术后续治疗方案的成熟数据较少。

方法

回顾性分析了 1971 年至 2007 年间诊断为毛细胞型星形细胞瘤的 10 名女性和 20 名男性患者。患者中位年龄为 30 岁（范围 18-64 岁），中位随访时间为 87 个月（范围 16-420 个月）。初始手术包括活检（10%的患者）、次全切除术（57%的患者）或大体全切除术（33%的患者）。19 名患者术后接受观察，11 名患者接受术后即刻辅助放疗（50 戈瑞，25 次）。无患者接受辅助或同期化疗。采用 Kaplan-Meier 法计算无进展生存期（PFS）和总生存期（OS）。采用对数秩检验分析生存曲线之间的差异。

结果

在整个队列中，5 年和 10 年 OS 率分别为 95%和 85%，5 年和 10 年 PFS 率分别为 63%和 35%。中位 PFS 为 8.4 年。与观察相比，初始放疗并未影响 OS，但显著改善了 PFS。观察组和放疗组的 5 年 PFS 率分别为 42%和 91%，10 年 PFS 率分别为 17%和 60%（P =.005）。观察组中进展的 19 名患者（11 名）接受了各种挽救性治疗，2 年 PFS 率为 68%，而初始放疗后进展（3 名）并接受化疗或手术挽救的患者（11 名）的 2 年 PFS 率为 33%（P =.1）。