Department of Radiation Oncology, Thomas Jefferson University, Kimmel Cancer Center, Bodine Cancer Center, 111 S. 11th Street, Philadelphia, PA 19107, USA.
Br J Cancer. 2011 Apr 26;104(9):1365-71. doi: 10.1038/bjc.2011.123. Epub 2011 Apr 12.
Patients with high-grade gliomas are treated with surgery followed by chemoradiation. The risk factors and implications of neurological side effects are not known.
Acute and late ≥ grade 3 neurological toxicities (NTs) were analysed among 2761 patients from 14 RTOG trials accrued from 1983 to 2003. The association between acute and late toxicity was analysed using a stepwise logistic regression model. The association between the occurrence of acute NT and survival was analysed as an independent variable.
There were 2610 analysable patients (86% glioblastoma, 10% anaplastic astrocytoma). All received a systemic agent during radiation (83% chemotherapy, 17% biological agents). Median radiation dose was 60 Gy. There were 182 acute and 83 late NT events. On univariate analysis, older age, poor performance status, aggressive surgery, pre-existing neurological dysfunction, poor mental status and twice-daily radiation were associated with increased acute NT. In a stepwise logistic regression model the occurrence of acute NT was significantly associated with late NT (OR=2.40; 95% CI=1.2-4.8; P=0.014). The occurrence of acute NT predicted poorer overall survival, independent of recursive partitioning analysis class (median 7.8 vs 11.8 months).
Acute NT is significantly associated with both late NT and overall survival.
高级别脑胶质瘤患者接受手术联合放化疗治疗。目前尚不清楚神经毒性的风险因素及其影响。
本研究分析了 1983 年至 2003 年期间 14 项 RTOG 试验共 2761 例患者的急性和迟发性≥3 级神经毒性（NTs）。采用逐步逻辑回归模型分析急性和迟发性毒性之间的相关性。将急性 NT 的发生作为独立变量分析其与生存的关系。
可分析的患者有 2610 例（86%为胶质母细胞瘤，10%为间变性星形细胞瘤）。所有患者在放疗期间均接受了全身治疗（83%为化疗，17%为生物制剂）。中位放疗剂量为 60Gy。发生急性 NT 有 182 例，迟发性 NT 有 83 例。单因素分析显示，年龄较大、一般状况较差、积极的手术、术前存在神经功能障碍、精神状态较差和每日 2 次放疗与急性 NT 增加相关。逐步逻辑回归模型中，急性 NT 的发生与迟发性 NT 显著相关（OR=2.40；95%CI=1.2-4.8；P=0.014）。急性 NT 的发生与总体生存显著相关，独立于递归分区分析类别（中位生存时间分别为 7.8 个月和 11.8 个月）。
急性 NT 与迟发性 NT 和总体生存均显著相关。
