放疗后表现状态不佳且无复发的大脑胶质瘤病：单机构经验
Gliomatosis cerebri having a poor performance status without recurrence after radiotherapy: a single institutional experience.
作者信息
Jung Tae-Young, Yoon Mee-Sun, Kim Young-Hee, Jung Shin, Kim In-Young, Jang Woo-Youl, Moon Kyung-Sub, Lee Kyung-Hwa, Kim Seul-Kee
机构信息
Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
Department of Radiation Oncology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju, South Korea.
出版信息
Clin Neurol Neurosurg. 2015 Mar;130:1-5. doi: 10.1016/j.clineuro.2014.12.006. Epub 2014 Dec 23.
OBJECTIVE
Radiotherapy (RT) has been advocated for gliomatosis cerebri (GC) to delay tumor progression. However, patients with GC may experience poor performance status without recurrence after RT. Herein, we reviewed the responses of patients with GC treated with RT.
MATERIALS AND METHODS
Seventeen patients with diffuse radiologic infiltration of more than two cerebral lobes and diagnosed as having grade II (N=12) or III (N=5) glioma were treated with a mean radiation dose of 51.8 Gy (range, 42-59.4 Gy). The mean radiation volume to a mean marginal dose of 42.8 Gy (range, 36-45 Gy) was 693.4 cc (range, 316.5-1279.6 cc), which was 45.3% of the mean whole brain volume. We reviewed the clinical prognostic factors related to progression-free survival (PFS) and overall survival (OS) in all patients and described characteristics of patients with poor performance (Eastern Cooperative Oncology Group performance scale 3-4) without recurrence.
RESULTS
In all patients, the median PFS was 12.3 months, and oligodendroglial pathology (p=0.002) and non-enhanced tumor (p=0.002) were associated with an improved PFS. The median OS was 39.3 months, and young age and adjuvant chemotherapy were associated with improved OS (p=0.022 and 0.002, respectively). Based on multivariate analysis, adjuvant chemotherapy was significantly associated with a longer OS (p=0.012; hazard ratio=0.099; 95% CI, 0.016-0.596). Five patients (29.4%) showed poor performance without recurrence. The median age of these 5 patients was 65 years (range, 60-75 years). The mean radiation volume to a mean marginal dose of 41 Gy (range, 36-45 Gy) was 539.9 cc (range, 255.5-983.1 cc). The pathologic diagnosis was grade II glioma in 2 patients and grade III in 3 patients. The median OS was 10.0 months (range, 8.2-45.9 months).
CONCLUSIONS
Some GC patients, especially the elderly, might have a poor performance status without recurrence after RT of a larger radiation field.
目的
放射治疗（RT）已被推荐用于大脑胶质瘤病（GC）以延缓肿瘤进展。然而，GC患者在放疗后可能出现身体状况不佳且无复发的情况。在此，我们回顾了接受RT治疗的GC患者的反应。
材料与方法
17例大脑有超过两个脑叶弥漫性放射学浸润且诊断为II级（n = 12）或III级（n = 5）胶质瘤的患者接受了平均51.8 Gy（范围42 - 59.4 Gy）的放射剂量治疗。平均边缘剂量为42.8 Gy（范围36 - 45 Gy）时的平均放射体积为693.4 cc（范围316.5 - 1279.6 cc），占平均全脑体积的45.3%。我们回顾了所有患者中与无进展生存期（PFS）和总生存期（OS）相关的临床预后因素，并描述了身体状况不佳（东部肿瘤协作组体能状态评分为3 - 4分）且无复发患者的特征。
结果
在所有患者中，中位PFS为12.3个月，少突胶质细胞病理类型（p = 0.002）和无强化肿瘤（p = 0.002）与PFS改善相关。中位OS为39.3个月，年轻和辅助化疗与OS改善相关（分别为p = 0.022和0.002）。基于多因素分析，辅助化疗与更长的OS显著相关（p = 0.012；风险比 = 0.099；95%CI，0.016 - 0.596）。5例患者（29.4%）表现为身体状况不佳且无复发。这5例患者的中位年龄为65岁（范围60 - 75岁）。平均边缘剂量为41 Gy（范围36 - 45 Gy）时的平均放射体积为539.9 cc（范围255.5 - 983.1 cc）。病理诊断为2例II级胶质瘤和3例III级胶质瘤。中位OS为10.0个月（范围8.2 - 45.9个月）。
结论
一些GC患者，尤其是老年患者，在接受较大放射野的RT后可能出现身体状况不佳且无复发的情况。
Zotero 插件