Shibamoto Y, Yamashita J, Takahashi M, Yamasaki T, Kikuchi H, Abe M
Department of Radiology, Faculty of Medicine, Kyoto University, Japan.
Radiother Oncol. 1990 May;18(1):9-17. doi: 10.1016/0167-8140(90)90018-r.
To analyze treatment results of supratentorial malignant gliomas in the megavoltage era, all the histologic specimens were reviewed and glioblastoma multiforme (GBM) was distinguished from anaplastic astrocytoma (AA) by the presence of necrosis. Among those who had completed radiotherapy and who had been followed for at least one year, 135 GBM and 43 AA patients were found. The median survival time (MST) after operation was 12 months for GBM and 18 months for AA. The 5-year survival rate was 0.9% for GBM and 18% for AA. The size of radiation field had little influence on survival time; MST was 12 months for GBM patients treated with a local field covering tumor plus less than 2 cm margin, 12 months for those treated with a generous field (2 cm or more margin), and 13 months for those treated to whole brain. Also for AA, whole brain radiation did not prolong survival. Initial relapse of GBM and AA developed within the irradiated volume in 86% of the cases treated with a generous field. Whole brain radiation seemed useless for the treatment of malignant gliomas. Survival time appeared to be dose-dependent; MST was 10, 13, and 16 months for GBM patients who received 45-57, 57-63, and 63-72 Gy, respectively. Extensive surgical resection was associated with a better prognosis in GBM. AA patients 60 years old or older had a poorer prognosis than younger patients, but age was not a significant prognostic factor for GBM. Chemotherapy appeared to prolong survival slightly without improving long-term survival.(ABSTRACT TRUNCATED AT 250 WORDS)
为分析兆伏级放疗时代幕上恶性胶质瘤的治疗结果，我们复查了所有组织学标本，并根据有无坏死将多形性胶质母细胞瘤（GBM）与间变性星形细胞瘤（AA）区分开来。在完成放疗且随访至少1年的患者中，共发现135例GBM患者和43例AA患者。GBM患者术后中位生存时间（MST）为12个月，AA患者为18个月。GBM患者的5年生存率为0.9%，AA患者为18%。照射野大小对生存时间影响不大；肿瘤局部加边缘小于2 cm的局部照射野治疗的GBM患者MST为12个月，大照射野（边缘2 cm或更宽）治疗的患者MST为12个月，全脑照射的患者MST为13个月。AA患者也是如此，全脑放疗并未延长生存期。大照射野治疗的病例中，86%的GBM和AA患者首次复发发生在照射野内。全脑放疗似乎对恶性胶质瘤治疗无效。生存时间似乎与剂量有关；接受45 - 57、57 - 63和63 - 72 Gy照射的GBM患者MST分别为10、13和16个月。广泛手术切除与GBM患者较好的预后相关。60岁及以上的AA患者预后比年轻患者差，但年龄不是GBM的显著预后因素。化疗似乎能略微延长生存期，但未改善长期生存。（摘要截选至250字）
