Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
J Neurooncol. 2012 Dec;110(3):369-74. doi: 10.1007/s11060-012-0972-7. Epub 2012 Sep 16.
Elderly or frail patients with high-grade gliomas (HGG) can be effectively treated with an abbreviated course of radiation therapy (RT) consisting of 40 Gy in 15 fractions. Concurrent temozolomide (TMZ) improves survival in non-elderly patients with glioblastoma treated with standard schedule of 60 Gy in 30 fractions. We describe our institutional experience of combining abbreviated RT with concurrent TMZ for treatment of HGG. Between 1/1/2004 and 2/5/2010 31 patients were treated. Survival was estimated with the Kaplan-Meier method. Toxicity was scored according to CTCAE 3.0. Median age was 66 years (range 32-90), and 17 patients had Karnofsky performance score <70. At the time of analysis, 30 patients (98 %) had died, with a followup of 14 months in the surviving patient. Median survival was 11 months (range 1-20), and 41 % of patients were alive at 12 months. Thirty patients (97 %) had a decreased corticosteroid requirement after completion of therapy. Only one new hospitalization for worsening neurologic status was required during therapy. Grade 3-4 hematologic toxicity occurred in 11 patients. Abbreviated RT with concurrent TMZ provides a clinical benefit, is safe and tolerable in patients of advanced age or poor functional status.
对于高级别胶质瘤（HGG）的老年或体弱患者，可以通过 40Gy/15 次分割的短程放射治疗（RT）进行有效治疗。同时使用替莫唑胺（TMZ）可改善非老年患者接受标准 60Gy/30 次分割治疗的生存情况。我们描述了使用缩短 RT 联合同时 TMZ 治疗 HGG 的机构经验。在 2004 年 1 月 1 日至 2010 年 2 月 5 日期间，共治疗了 31 例患者。采用 Kaplan-Meier 法估计生存情况。毒性根据 CTCAE 3.0 评分。中位年龄为 66 岁（范围 32-90），17 例患者 Karnofsky 表现评分为<70。在分析时，30 例患者（98%）死亡，存活患者的随访时间为 14 个月。中位生存时间为 11 个月（范围 1-20），12 个月时 41%的患者存活。30 例患者（97%）在治疗完成后需要减少皮质类固醇的使用。在治疗期间仅需要进行 1 次新的因神经状态恶化而住院治疗。11 例患者出现 3-4 级血液学毒性。缩短 RT 联合同时 TMZ 治疗可在高龄或功能状态较差的患者中提供临床获益，并且安全耐受。
