Elsamadicy Aladine A, Babu Ranjith, Kirkpatrick John P, Adamson David Cory
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA.
World Neurosurg. 2015 Apr;83(4):530-42. doi: 10.1016/j.wneu.2014.12.009. Epub 2014 Dec 16.
Radiation-induced malignant gliomas (RIMGs) are known uncommon risks of brain irradiation. We describe 4 cases of RIMG that occurred at our institution and conduct the largest comprehensive review of the literature to characterize RIMGs better.
Patients were identified through the PubMed database. Pearson R linear correlation test was used to evaluate the correlation between radiotherapy (RT) dose and age and latency period. Student t test was used to evaluate differences between latency periods for original tumor lesions. A normalized biologic equivalent dose analysis was performed to indicate the minimum and maximum radiation threshold for neoplasia. A Kaplan-Meier analysis was used to illustrate the overall survival curves.
The analysis included 172 cases from the PubMed database and 4 cases occurring at our institution. The median RT dose administered was 35.6 Gy, with the most common dosage ranges being 21-30 Gy (31%) and 41-50 Gy (21.5%). Median latency period was 9 years until diagnosis of RIMG, and RIMG occurred within 15 years in 82% of the patients. There was no correlation between the age of the patient at the time RT was administered (R(2) = 0.00081) or amount of RT (R(2) = 0.00005) and latency period for RIMG. The mean biologic equivalent dose for neoplasia of a RIMG was 63.3 Gy. The median survival of patients with RIMG improved over time (P = 0.004), with median survival of 9 months before 2007 and 11.5 months after 2007.
The risk of RIMG appears to be the same for all age groups, histologies, and RT dosages. Although the risk is low, patients should be aware of RIMG as a possible complication of brain irradiation.
放射性诱发恶性胶质瘤（RIMGs）是脑部放疗已知的罕见风险。我们描述了在我们机构发生的4例RIMG病例，并对文献进行了最大规模的全面综述，以更好地描述RIMGs的特征。
通过PubMed数据库识别患者。采用Pearson R线性相关检验评估放疗（RT）剂量与年龄及潜伏期之间的相关性。采用Student t检验评估原发肿瘤病变潜伏期的差异。进行标准化生物等效剂量分析以表明肿瘤形成的最小和最大辐射阈值。采用Kaplan-Meier分析绘制总生存曲线。
分析包括来自PubMed数据库的172例病例以及在我们机构发生的4例病例。给予的RT中位剂量为35.6 Gy，最常见的剂量范围是21 - 30 Gy（31%）和41 - 50 Gy（21.5%）。RIMG诊断前的中位潜伏期为9年，82%的患者在15年内发生RIMG。给予RT时患者的年龄（R² = 0.00081）或RT剂量（R² = 0.00005）与RIMG的潜伏期之间无相关性。RIMG肿瘤形成的平均生物等效剂量为63.3 Gy。RIMG患者的中位生存期随时间有所改善（P = 0.004），2007年前中位生存期为9个月，2007年后为11.5个月。
RIMG的风险在所有年龄组、组织学类型和RT剂量中似乎相同。尽管风险较低，但患者应知晓RIMG是脑部放疗可能的并发症。
