Hernandez J C, Maruyama Y, Yaes R, Chin H W
Department of Radiation Medicine, University of Kentucky Medical Center, Lexington.
J Neurooncol. 1990 Aug;9(1):41-5. doi: 10.1007/BF00167067.
The standard 6 week course of post-operative radiotherapy for glioblastoma multiforme (astrocytoma grade IV) is lengthy, considering the poor prognosis. The standard schedule is especially unsuitable for hospitalized patients and for those with poor prognostic factors (such as old age and poor performance status) since their survival is particularly short. In order to improve the survival-treatment time ratio, we entered a total of 14 hospitalized patients with glioblastoma multiforme (GBM) and poor prognostic factors (mean age 62, mean KPS 57%) into a Phase I trial of accelerated fractionation (AF) external beam radiotherapy. A total tumor dose of 5400-5500 cGy was given in 3 weeks: 4300-4500 cGy whole brain using 100 cGy tid fractions on weekdays plus a 900-1200 cGy boost using single daily fractions of 150-200 cGy on weekends. Only one patient entered did not complete therapy, due to the development of pulmonary embolism resulting in death. Mean survival for all 14 patients from the time of surgical diagnosis was 30.4 weeks. The schedule was well tolerated and resulted in a substantial decrease in treatment time compared to conventional fractionation in these patients. AF schedules should continue to be explored since they may be more appropriate than conventional fractionation schedules for GBM patients with poor prognostic factors, particularly when hospitalized.
考虑到多形性胶质母细胞瘤（星形细胞瘤IV级）预后较差，其术后放疗的标准6周疗程较长。标准放疗方案尤其不适用于住院患者以及那些具有不良预后因素的患者（如老年和功能状态差），因为他们的生存期特别短。为了提高生存-治疗时间比，我们将总共14例患有多形性胶质母细胞瘤（GBM）且具有不良预后因素的住院患者（平均年龄62岁，平均KPS为57%）纳入了一项加速分割（AF）外照射放疗的I期试验。在3周内给予总肿瘤剂量5400 - 5500 cGy：工作日使用100 cGy每日3次分割对全脑照射4300 - 4500 cGy，周末使用150 - 200 cGy每日单次分割追加900 - 1200 cGy。仅1例入组患者因发生肺栓塞导致死亡而未完成治疗。所有14例患者从手术诊断时起的平均生存期为30.4周。该方案耐受性良好，与这些患者的常规分割相比，治疗时间大幅缩短。对于具有不良预后因素的GBM患者，尤其是住院患者，AF方案可能比常规分割方案更合适，因此应继续探索AF方案。
