Dincoglan Ferrat, Beyzadeoglu Murat, Sager Omer, Demiral Selcuk, Gamsiz Hakan, Uysal Bora, Ebruli Cuneyt, Akin Mustafa, Oysul Kaan, Sirin Sait, Dirican Bahar
Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.
Tumori. 2015 Mar-Apr;101(2):179-84. doi: 10.5301/tj.5000236. Epub 2015 Mar 19.
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. The chance of cure is very limited due to treatment-refractory disease course with frequent recurrences despite aggressive multimodality management. In this retrospective study, we evaluated treatment outcomes of hypofractionated stereotactic radiotherapy (HFSRT) in the management of recurrent GBM and report our single-center experience.
Twenty-eight patients receiving HFSRT for recurrent GBM between September 2008 and February 2014 were retrospectively assessed. Total radiotherapy dose was 25 Gy delivered in 5 fractions over 5 consecutive days for all patients. High-precision, image-guided volumetric modulated arc therapy was delivered with a linear accelerator using 6-MV photons using the frameless technique. Analyzed prognostic factors were age, gender, Karnofsky performance status (KPS), tumor location, planning target volume (PTV) size, overall survival (OS), progression-free survival (PFS), time interval between completion of treatment with Stupp protocol at primary diagnosis and recurrence.
Median follow-up time was 42 months (range 2-68). Median time interval between primary chemoradiotherapy and HFSRT was 11.2 months (range 4-57.9). Median OS and PFS calculated from reirradiation was 10.3 months and 5.8 months, respectively. Longer interval between initial treatment and recurrence (p = 0.01), smaller PTV size (p = 0.001), KPS ≥70 (p = 0.005) and younger age (p = 0.004) were associated with longer OS on statistical analysis.
HFSRT offers a feasible and effective salvage treatment option for recurrent GBM management. Prognostic factors associated with longer OS in our study were longer interval between initial treatment and recurrence, smaller PTV size, KPS ≥70 and younger age.
胶质母细胞瘤（GBM）是成人中最常见的原发性恶性脑肿瘤。尽管采取了积极的多模式治疗，但由于疾病进程难治且频繁复发，治愈的机会非常有限。在这项回顾性研究中，我们评估了低分割立体定向放射治疗（HFSRT）在复发性GBM治疗中的效果，并报告我们的单中心经验。
回顾性评估了2008年9月至2014年2月期间28例接受HFSRT治疗复发性GBM的患者。所有患者均接受总放疗剂量25 Gy，分5次在连续5天内给予。使用直线加速器，采用6-MV光子，运用无框架技术进行高精度图像引导容积调强弧形治疗。分析的预后因素包括年龄、性别、卡诺夫斯基功能状态（KPS）、肿瘤位置、计划靶体积（PTV）大小、总生存期（OS）、无进展生存期（PFS）、初次诊断时完成Stupp方案治疗与复发之间的时间间隔。
中位随访时间为42个月（范围2 - 68个月）。初次放化疗与HFSRT之间的中位时间间隔为11.2个月（范围4 - 57.9个月）。再次放疗后的中位OS和PFS分别为10.3个月和5.8个月。统计分析显示，初始治疗与复发之间的间隔时间更长（p = 0.01）、PTV体积更小（p = 0.001）、KPS≥70（p = 0.005）以及年龄更小（p = 0.004）与更长的OS相关。
HFSRT为复发性GBM的治疗提供了一种可行且有效的挽救治疗选择。在我们的研究中，与更长OS相关的预后因素是初始治疗与复发之间的间隔时间更长、PTV体积更小、KPS≥70以及年龄更小。
