Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO 80045-0508, USA.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):655-60. doi: 10.1016/j.ijrobp.2012.01.035. Epub 2012 Apr 5.
To report toxicity and overall survival (OS) in patients with newly diagnosed glioblastoma multiforme (GBM) treated with hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent and adjuvant temozolomide (TMZ).
Patients with newly diagnosed GBM after biopsy or resection and with adequate performance status and organ or bone marrow function were eligible for this study. Patients received postoperative hypo-IMRT to the surgical cavity and residual tumor seen on T1-weighted brain MRI with a 5-mm margin to a total dose of 60 Gy in 10 fractions (6 Gy/fraction) and to the T2 abnormality on T2-weighted MRI with 5-mm margin to 30 Gy in 10 fractions (3 Gy/fraction). Concurrent TMZ was given at 75 mg/m(2)/day for 28 consecutive days. Adjuvant TMZ was given at 150 to 200 mg/m(2)/day for 5 days every 28 days. Toxicities were defined using Common Terminology Criteria for Adverse Events version 3.0.
Twenty-four patients were treated, consisting of 14 men, 10 women; a median age of 60.5 years old (range, 27-77 years); and a median Karnofsky performance score of 80 (range, 60-90). All patients received hypo-IMRT and concurrent TMZ according to protocol, except for 2 patients who received only 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 6.5 (range, 0-14).With a median follow-up of 14.8 months (range, 2.7-34.2 months) for all patients and a minimum follow-up of 20.6 months for living patients, no instances of grade 3 or higher nonhematologic toxicity were observed. The median OS was 16.6 months (range, 4.1-35.9 months). Six patients underwent repeated surgery for suspected tumor recurrence; necrosis was found in 50% to 100% of the resected specimens.
In selected GBM patients, 60 Gy hypo-IMRT delivered in 6-Gy fractions over 2 weeks with concurrent and adjuvant TMZ is safe. OS in this small cohort of patients was comparable to that treated with current standard of care therapy.
报告接受低分割调强放疗（hypo-IMRT）联合替莫唑胺（TMZ）辅助治疗新诊断的多形性胶质母细胞瘤（GBM）患者的毒性和总生存期（OS）。
经活检或切除、一般状况良好、器官或骨髓功能正常的新诊断 GBM 患者符合本研究入组条件。患者接受术后 hypo-IMRT，范围包括手术腔和 T1 加权脑 MRI 上可见的残留肿瘤，边缘外放 5mm，总剂量 60Gy，分割 10 次（每次 6Gy）；T2 加权 MRI 上 T2 异常边缘外放 5mm，总剂量 30Gy，分割 10 次（每次 3Gy）。同步给予 TMZ 75mg/m²/天，连用 28 天。辅助给予 TMZ 150-200mg/m²/天，连用 5 天，每 28 天重复。毒性采用通用不良事件术语标准 3.0 进行定义。
共 24 例患者接受治疗，包括 14 例男性，10 例女性；中位年龄 60.5 岁（范围，27-77 岁）；中位 Karnofsky 表现状态评分为 80（范围，60-90）。除 2 例患者仅接受 14 天同步 TMZ 治疗外，所有患者均按方案接受 hypo-IMRT 和同步 TMZ 治疗。中位辅助 TMZ 周期数为 6.5（范围，0-14）。所有患者中位随访 14.8 个月（范围，2.7-34.2 个月），存活患者的最小随访时间为 20.6 个月。未观察到 3 级或更高级别的非血液学毒性。中位 OS 为 16.6 个月（范围，4.1-35.9 个月）。6 例患者因怀疑肿瘤复发而行再次手术，切除标本中 50%-100%为坏死组织。
在选择的 GBM 患者中，2 周内接受 60Gy hypo-IMRT（每次 6Gy，分割 10 次）联合同步和辅助 TMZ 治疗是安全的。该小队列患者的 OS 与采用目前标准治疗的患者相当。
