Kim Brian, Soisson Emilie, Duma Christopher, Chen Peter, Hafer Russell, Cox Craig, Cubellis Jim, Minion Annamarie, Plunkett Marianne, Mackintosh Ralph
Hoag Memorial Hospital Presbyterian, USA.
Clin Neurol Neurosurg. 2011 Jul;113(6):509-12. doi: 10.1016/j.clineuro.2011.02.001. Epub 2011 Mar 9.
Salvage treatment of high grade gliomas that progress after standard therapy of resection and adjuvant chemoradiation therapy includes repeat surgical resection, second line chemotherapy, re-irradiation, or often a combination of the above. We present a series on patients treated with hypofractionated stereotactic image-guided helical tomotherapy and discuss the efficacy of this new technology in the treatment of high grade gliomas.
Between June 2005 and August of 2008, eight patients with recurrent high grade gliomas were treated with salvage radiation therapy using hypofractionated stereotactic image-guided helical tomotherapy after image documentation of disease progression. Median age was 48.5 years with 4 females and 4 males. Median KPS at time of treatment was 65. All patients had either Grade III or IV gliomas at time of treatment with previous history of involved field fractionated radiotherapy. Median total dose given was 2500cGy in 500cGy fractions.
The median planning target volume was 69.5cm(3). Five of the eight patients were alive at the time of last follow-up with a median survival of 7.6 months. Radiographic documented control was seen in six of the eight patients with median local control of 4.6 months. Acute Radiation Therapy Oncology Group (RTOG) toxicity scores measured zero in all patients with only one patient requiring a reoperation following treatment.
Hypofractionated stereotactic image-guided helical tomotherapy provides an alternative to other stereotactic radiation therapy and radiosurgery options for treatment of recurrent high grade gliomas.
高级别胶质瘤在接受手术切除及辅助放化疗等标准治疗后出现进展时，挽救性治疗包括再次手术切除、二线化疗、再次放疗，或常常是上述方法的联合应用。我们报告一组接受低分次立体定向图像引导螺旋断层放疗的患者，并讨论这项新技术在高级别胶质瘤治疗中的疗效。
2005年6月至2008年8月期间，8例复发性高级别胶质瘤患者在疾病进展经影像学记录后，接受了低分次立体定向图像引导螺旋断层放疗的挽救性放疗。中位年龄为48.5岁，4例女性，4例男性。治疗时的中位KPS为65。所有患者在治疗时均为Ⅲ级或Ⅳ级胶质瘤，既往有累及野分割放疗史。给予的中位总剂量为2500cGy，分500cGy每次。
中位计划靶体积为69.5cm³。8例患者中有5例在最后一次随访时存活，中位生存期为7.6个月。8例患者中有6例影像学记录显示有控制，中位局部控制时间为4.6个月。所有患者的急性放射治疗肿瘤学组（RTOG）毒性评分均为零，仅1例患者在治疗后需要再次手术。
低分次立体定向图像引导螺旋断层放疗为复发性高级别胶质瘤的治疗提供了一种替代其他立体定向放射治疗和放射外科治疗的选择。
