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新诊断弥漫性内生脑桥胶质瘤的低分割放疗与常规放疗的比较:匹配队列分析。

Hypofractionation vs conventional radiation therapy for newly diagnosed diffuse intrinsic pontine glioma: a matched-cohort analysis.

机构信息

Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

出版信息

Int J Radiat Oncol Biol Phys. 2013 Feb 1;85(2):315-20. doi: 10.1016/j.ijrobp.2012.04.006. Epub 2012 Jun 9.

Abstract

PURPOSE

Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy given over 3 to 4 weeks. A 1:1 matched-cohort analysis with conventional radiation therapy was performed to assess response and survival.

METHODS AND MATERIALS

Twenty-seven children, aged 3 to 14, were treated according to 1 of 2 hypofractionation regimens over 3 to 4 weeks (39/3 Gy, n=16 or 44.8/2.8 Gy, n=11). All patients had symptoms for ≤3 months, ≥2 signs of the neurologic triad (cranial nerve deficit, ataxia, long tract signs), and characteristic features of DIPG on magnetic resonance imaging. Twenty-seven patients fulfilling the same diagnostic criteria and receiving at least 50/1.8 to 2.0 Gy were eligible for the matched-cohort analysis.

RESULTS

With hypofractionation radiation therapy, the overall survival at 6, 9, and 12 months was 74%, 44%, and 22%, respectively. Progression-free survival at 3, 6, and 9 months was 77%, 43%, and 12%, respectively. Temporary discontinuation of steroids was observed in 21 of 27 (78%) patients. No significant difference in median overall survival (9.0 vs 9.4 months; P=.84) and time to progression (5.0 vs 7.6 months; P=.24) was observed between hypofractionation vs conventional radiation therapy, respectively.

CONCLUSIONS

For patients with newly diagnosed DIPG, a hypofractionation regimen, given over 3 to 4 weeks, offers equal overall survival with less treatment burden compared with a conventional regimen of 6 weeks.

摘要

目的

尽管采用了常规放疗,即单次剂量 1.8 Gy(54/1.8 Gy),共 6 周,但大多数弥漫性内在脑桥胶质瘤(DIPG)患儿在诊断后 1 年内仍会死亡。为了减轻患者负担,我们研究了在 3 至 4 周内进行分次放疗的作用。我们进行了 1:1 匹配队列分析,以评估常规放疗的疗效和生存率。

方法和材料

27 名年龄在 3 至 14 岁的儿童,按照 3 至 4 周内的 2 种分次放疗方案之一进行治疗(39/3 Gy,n=16 或 44.8/2.8 Gy,n=11)。所有患者的症状持续时间均≤3 个月,均存在神经三联征(颅神经缺陷、共济失调、长束体征)中的≥2 个体征,且磁共振成像上具有 DIPG 的特征性表现。27 名符合相同诊断标准且接受至少 50/1.8 至 2.0 Gy 放疗的患者有资格进行匹配队列分析。

结果

采用分次放疗,6、9 和 12 个月的总生存率分别为 74%、44%和 22%。3、6 和 9 个月的无进展生存率分别为 77%、43%和 12%。27 名患者中有 21 名(78%)患者临时停用了类固醇。与常规放疗相比,分次放疗的中位总生存期(9.0 个月比 9.4 个月;P=.84)和进展时间(5.0 个月比 7.6 个月;P=.24)均无显著差异。

结论

对于新诊断为 DIPG 的患者,与 6 周常规放疗相比,3 至 4 周的分次放疗方案具有相同的总生存率,但治疗负担较轻。

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