Pinzi Valentina, Orsi Chiara, Marchetti Marcello, Milanesi Ida Maddalena, Bianchi Livia Corinna, DiMeco Francesco, Cuccarini Valeria, Farinotti Mariangela, Ferroli Paolo, Finocchiaro Gaetano, Franzini Angelo, Fumagalli MariaLuisa, Silvani Antonio, Fariselli Laura
Radiotherapy Unit, Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, MI, Italy,
Neurol Sci. 2015 Aug;36(8):1431-40. doi: 10.1007/s10072-015-2172-7. Epub 2015 Mar 25.
Despite various treatment strategies being available, recurrent high-grade gliomas (r-HGG) are difficult to manage. To obtain local control, radiosurgery (SRS) reirradiation has been considered as potential treatment. In the present study, a retrospective analysis was performed on r-HGG patients treated with salvage single- (s-SRS) or multi-fraction SRS (m-SRS). The aim of this study was to evaluate the effectiveness of salvage SRS in terms of overall survival (OS); toxicity was analyzed as well. Between 2004 May and 2011 December, 128 r-HGG patients (161 lesions) treated with CyberKnife(®) SRS reirradiation were retrospectively analyzed. Toxicity was graded according to Radiation Therapy Oncology Group and by Common Terminology Criteria for Adverse Events v.3 criteria. OS from the diagnosis date and OS from reirradiation were estimated using the Kaplan-Meier method. Median follow-up was 9 months (range 15 days-82 months). All patients completed SRS without high-grade toxicity. Radiation necrosis was observed in seven patients (6 %) with large volume lesions. The median survival from initial diagnosis was 32 months. The 1-, 2-, and 3-years survival rates from diagnosis were 95, 62, and 45 % respectively. Median survival following SRS was 11.5 months. The 1-, 2-, and 3-years survival rate following SRS was 48, 20, and 17 % respectively. On multivariate analysis, age <40 years, salvage surgery before SRS, and other post-SRS therapies (second-line chemotherapy and/or surgery) were found to significantly improve survival (p = 0.03). SRS represents a safe and feasible option to treat r-HGG patients with low complication rates and potential survival benefit.
尽管有多种治疗策略可供选择，但复发性高级别胶质瘤（r-HGG）仍难以治疗。为实现局部控制，立体定向放射外科（SRS）再程放疗被视为一种潜在的治疗方法。在本研究中，对接受挽救性单次（s-SRS）或多分次SRS（m-SRS）治疗的r-HGG患者进行了回顾性分析。本研究的目的是评估挽救性SRS在总生存期（OS）方面的有效性；同时也对毒性进行了分析。2004年5月至2011年12月期间，对128例接受射波刀（®）SRS再程放疗的r-HGG患者（161个病灶）进行了回顾性分析。毒性根据放射治疗肿瘤学组以及不良事件通用术语标准第3版标准进行分级。采用Kaplan-Meier方法估计从诊断日期开始的OS以及再程放疗后的OS。中位随访时间为9个月（范围15天至82个月）。所有患者均完成了SRS，且无高级别毒性反应。7例（6%）大体积病灶患者出现了放射性坏死。从初始诊断开始的中位生存期为32个月。从诊断开始的1年、2年和3年生存率分别为95%、62%和45%。SRS后的中位生存期为11.5个月。SRS后的1年、2年和3年生存率分别为48%、20%和17%。多因素分析显示，年龄<40岁、SRS前的挽救性手术以及其他SRS后的治疗（二线化疗和/或手术）可显著改善生存期（p = 0.03）。SRS是治疗r-HGG患者的一种安全可行的选择，并发症发生率低且可能有生存获益。
