Yoon Sang Min, Kim Jeong Hoon, Kim Sang Joon, Khang Shin Kwang, Shin Seong Soo, Cho Young Hyun, Jwa Eunjin, Park Jin-Hong, Ahn Seung Do
Tumori. 2013 Jul-Aug;99(4):480-7. doi: 10.1177/030089161309900407.
We assessed the therapeutic efficacy of combined hypofractionated intensity-modulated radiotherapy with temozolomide in patients with primary glioblastoma.
Thirty-nine patients with histologically confirmed glioblastoma were accrued. Using the simultaneous integrated boost technique, a dose of 50 Gy in 5-Gy fractions was applied to the gross tumor volume, together with 40 Gy in 4-Gy fractions and 30 Gy in 3-Gy fractions to the 1- and 2-cm margins from the gross tumor volume, respectively. Patients were also treated with concurrent temozolomide during intensity-modulated radiotherapy, followed by six cycles of adjuvant temozolomide.
Median follow-up was 16.8 months (range, 4.3-54.3). Tumor progression was observed in 28 patients (71.8%), and the median time to progression was 6.8 months. Median survival was 16.8 months, and it was affected significantly by the extent of surgery. During adjuvant temozolomide treatment, 3 patients (9.7%) developed grade 3-4 hematologic or hepatic toxicity. Radiation necrosis developed in 7 patients (17.9%) and massive necrosis, requiring emergency surgery, in 1 patient (2.6%).
The regimen of hypofractionated intensity-modulated radiotherapy with temozolomide showed a relatively good outcome in patients with glioblastoma. Further studies are required to define the optimal fraction size for glioblastoma using this highly sophisticated radiation technique.
我们评估了超分割调强放疗联合替莫唑胺治疗原发性胶质母细胞瘤患者的疗效。
纳入39例经组织学确诊的胶质母细胞瘤患者。采用同步整合加量技术，对大体肿瘤体积给予50 Gy、每次5 Gy的剂量，对距大体肿瘤体积1 cm和2 cm边缘分别给予40 Gy、每次4 Gy和30 Gy、每次3 Gy的剂量。患者在调强放疗期间同时接受替莫唑胺治疗，随后进行6个周期的辅助替莫唑胺治疗。
中位随访时间为16.8个月（范围4.3 - 54.3个月）。28例患者（71.8%）观察到肿瘤进展，中位进展时间为6.8个月。中位生存期为16.8个月，且受手术范围的显著影响。在辅助替莫唑胺治疗期间，3例患者（9.7%）出现3 - 4级血液学或肝脏毒性。7例患者（17.9%）发生放射性坏死，1例患者（2.6%）发生大面积坏死，需要急诊手术。
超分割调强放疗联合替莫唑胺方案在胶质母细胞瘤患者中显示出相对较好的疗效。需要进一步研究以确定使用这种高度复杂的放疗技术治疗胶质母细胞瘤的最佳分割剂量。
