替莫唑胺时代多形性胶质母细胞瘤的放射治疗剂量递增。

Radiation therapy dose escalation for glioblastoma multiforme in the era of temozolomide.

机构信息

Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.

Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.

出版信息

Int J Radiat Oncol Biol Phys. 2014 Nov 15;90(4):877-85. doi: 10.1016/j.ijrobp.2014.07.014. Epub 2014 Sep 23.

DOI:10.1016/j.ijrobp.2014.07.014

PMID:25257812

Abstract

PURPOSE

To review clinical outcomes of moderate dose escalation using high-dose radiation therapy (HDRT) in the setting of concurrent temozolomide (TMZ) in patients with newly diagnosed glioblastoma multiforme (GBM), compared with standard-dose radiation therapy (SDRT).

METHODS AND MATERIALS

Adult patients aged <70 years with biopsy-proven GBM were treated with SDRT (60 Gy at 2 Gy per fraction) or with HDRT (>60 Gy) and TMZ from 2000 to 2012. Biological equivalent dose at 2-Gy fractions was calculated for the HDRT assuming an α/β ratio of 5.6 for GBM.

RESULTS

Eighty-one patients received SDRT, and 128 patients received HDRT with a median (range) biological equivalent dose at 2-Gy fractions of 64 Gy (61-76 Gy). Overall median follow-up time was 1.10 years, and for living patients it was 2.97 years. Actuarial 5-year overall survival (OS) and progression-free survival (PFS) rates for patients that received HDRT versus SDRT were 12.4% versus 13.2% (P=.71), and 5.6% versus 4.1% (P=.54), respectively. Age (P=.001) and gross total/near-total resection (GTR/NTR) (P=.001) were significantly associated with PFS on multivariate analysis. Younger age (P<.0001), GTR/NTR (P<.0001), and Karnofsky performance status ≥80 (P=.001) were associated with improved OS. On subset analyses, HDRT failed to improve PFS or OS for those aged <50 years or those who had GTR/NTR.

CONCLUSION

Moderate radiation therapy dose escalation above 60 Gy with concurrent TMZ does not seem to improve clinical outcomes for patients with GBM.

摘要

目的

回顾在替莫唑胺（TMZ）同期治疗新诊断的多形性胶质母细胞瘤（GBM）患者中，与标准剂量放疗（SDRT）相比，采用大剂量放疗（HDRT）进行中剂量递增的临床结果。

方法和材料

2000 年至 2012 年，对经活检证实的年龄<70 岁的 GBM 成年患者采用 SDRT（60 Gy，2 Gy/次）或 HDRT（>60 Gy）和 TMZ 治疗。假设 GBM 的α/β 比值为 5.6，对 HDRT 以 2 Gy 分数计算生物等效剂量。

结果

81 例患者接受 SDRT，128 例患者接受 HDRT，中位数（范围）2 Gy 分数的生物等效剂量为 64 Gy（61-76 Gy）。中位总随访时间为 1.10 年，对于存活患者为 2.97 年。接受 HDRT 与 SDRT 的患者的 5 年总生存率（OS）和无进展生存率（PFS）分别为 12.4%和 13.2%（P=.71）和 5.6%和 4.1%（P=.54）。多变量分析显示，年龄（P=.001）和大体全切除/近全切除（GTR/NTR）（P=.001）与 PFS 显著相关。年龄较小（P<.0001）、GTR/NTR（P<.0001）和 Karnofsky 表现状态≥80（P=.001）与 OS 提高相关。在亚组分析中，HDRT 未能改善年龄<50 岁或 GTR/NTR 的患者的 PFS 或 OS。