University Hospital of Heidelberg, Department of Radiation Oncology, Heidelberg, Germany.
Acta Oncol. 2013 Jan;52(1):147-52. doi: 10.3109/0284186X.2012.692882. Epub 2012 Jun 11.
Re-irradiation using high-precision radiation techniques has been established within the clinical routine for patients with recurrent gliomas. In the present work, we developed a practical prognostic score to predict survival outcome after re-irradiation.
Fractionated stereotactic radiotherapy (FSRT) was applied in 233 patients. Primary histology included glioblastoma (n = 89; 38%), WHO Grade III gliomas (n = 52; 22%) and low-grade glioma (n = 92; 40%). FSRT was applied with a median dose of 36 Gy in 2 Gy single fractions. We evaluated survival after re-irradiation as well as progression-free survival after re-irradiation; prognostic factors analyzed included age, tumor volume at re-irradiation, histology, time between initial radiotherapy and re-irradiation, age and Karnofsky Performance Score.
Median survival after FSRT was 8 months for glioblastoma, 20 months for anaplastic gliomas, and 24 months for recurrent low-grade patients. The strongest prognostic factors significantly impacting survival after re-irradiation were histology (p < 0.0001) and age (< 50 vs. ≥ 50, p < 0.0001) at diagnosis and the time between initial radiotherapy and re-irradiation ≤ 12 vs. > 12 months (p < 0.0001). We generated a four-class prognostic score to distinguish patients with excellent (0 points), good (1 point), moderate (2 points) and poor (3-4 points) survival after re-irradiation. The difference in outcome was highly significant (p < 0.0001).
We generated a practical prognostic score index based on three clinically relevant factors to predict the benefit of patients from re-irradiation. This score index can be helpful in patient counseling, and for the design of further clinical trials. However, individual treatment decisions may include other patient-related factors not directly influencing outcome.
使用高精度放射技术对复发性脑胶质瘤患者进行再放疗已在临床常规中确立。在本工作中，我们开发了一种实用的预后评分来预测再放疗后的生存结果。
对 233 例患者进行分次立体定向放疗（FSRT）。主要组织学包括胶质母细胞瘤（n=89；38%）、WHO 分级 III 级胶质瘤（n=52；22%）和低级别胶质瘤（n=92；40%）。FSRT 应用中位数剂量为 36 Gy，单次分割 2 Gy。我们评估了再放疗后的生存情况以及再放疗后的无进展生存情况；分析的预后因素包括年龄、再放疗时的肿瘤体积、组织学、初始放疗与再放疗之间的时间、年龄和 Karnofsky 表现评分。
FSRT 后中位生存时间为胶质母细胞瘤 8 个月，间变性神经胶质瘤 20 个月，复发性低级别患者 24 个月。对再放疗后生存有显著影响的最强预后因素是组织学（p<0.0001）和诊断时的年龄（<50 岁与≥50 岁，p<0.0001）以及初始放疗与再放疗之间的时间≤12 个月与>12 个月（p<0.0001）。我们生成了一个四分类预后评分，以区分再放疗后生存良好（0 分）、较好（1 分）、中等（2 分）和较差（3-4 分）的患者。结果差异具有高度显著性（p<0.0001）。
我们基于三个临床相关因素生成了一个实用的预后评分指数，以预测患者从再放疗中获益的情况。该评分指数有助于患者咨询和进一步临床试验的设计。然而，个别治疗决策可能包括其他不直接影响预后的患者相关因素。
