老年新诊断胶质母细胞瘤患者中，低分割放疗与标准分割放疗联合替莫唑胺的对比研究
Hypofractionated radiation therapy versus standard fractionated radiation therapy with concurrent temozolomide in elderly patients with newly diagnosed glioblastoma.
作者信息
Wang Tony J C, Wu Cheng-Chia, Jani Ashish, Estrada Juan, Ung Timothy, Chow Daniel S, Soun Jennifer E, Saad Shumaila, Qureshi Yasir H, Gartrell Robyn, Saadatmand Heva J, Saraf Anurag, Garrett Matthew D, Grubb Christopher, Isaacson Steven R, Cheng Simon K, Sisti Michael B, Bruce Jeffrey N, Sheth Sameer A, Lassman Andrew B, Iwamoto Fabio M, McKhann Guy M
机构信息
Department of Radiation Oncology, Columbia University Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
Department of Radiation Oncology, Columbia University Medical Center, New York, New York.
出版信息
Pract Radiat Oncol. 2016 Sep-Oct;6(5):306-314. doi: 10.1016/j.prro.2015.12.001. Epub 2015 Dec 4.
PURPOSE
Adjuvant hypofractionated radiation therapy (HRT) for elderly patients with newly diagnosed glioblastoma (GBM) is a reasonable option compared with standard fractionation radiation therapy (SFRT). Outcomes in patients receiving HRT in the presence of temozolomide (TMZ) compared with SFRT with TMZ are unclear. We examined HRT for GBM with TMZ in comparison to SFRT with TMZ.
METHODS AND MATERIALS
We conducted a retrospective analysis of patients ≥60 years of age with newly diagnosed GBM who received SFRT or HRT from 1994 to 2014 in the postoperative setting. Inclusion criteria included SFRT (60 Gy/30 fractions or 59.4 Gy/33 fractions) versus HRT (40 Gy/15 fractions).
RESULTS
In this cohort, 158 patients were treated with SFRT versus 26 with HRT. Median survival in patients receiving SFRT compared with HRT was 430 and 475 days (P = .550), respectively. Ninety-five percent of the SFRT patients received TMZ versus 100% of those treated with HRT. Patients receiving HRT were older (median, 72 vs 66 years). All HRT patients were treated with the intensity modulated radiation therapy (IMRT) technique versus SFRT, in which 57% had IMRT. Multivariate Cox regression showed decreased overall survival (OS) associated with patient age >70 (hazard ratio [HR], 1.84), lower Karnofsky performance status (HR, 5.25), biopsy versus surgical resection (HR, 4.18), radiation therapy planning technique 3- or 2-dimensional planning versus IMRT (HR, 1.91; HR, 3.40, respectively). Analysis restricted to patients receiving IMRT-based planning showed no difference in OS between HRT and SFRT. For patients receiving TMZ, there was no survival difference between those treated with HRT and those treated with SFRT.
CONCLUSIONS
Elderly GBM patients receiving HRT and those receiving SFRT had similar OS. Subset analysis patients receiving concurrent TMZ showed no difference in OS between the HRT and SFRT groups.
目的
与标准分割放疗（SFRT）相比，辅助低分割放疗（HRT）对新诊断的胶质母细胞瘤（GBM）老年患者是一种合理的选择。与TMZ同步进行SFRT相比，TMZ同步进行HRT的患者结局尚不清楚。我们比较了TMZ同步进行HRT与TMZ同步进行SFRT治疗GBM的效果。
方法和材料
我们对1994年至2014年术后接受SFRT或HRT的≥60岁新诊断GBM患者进行了回顾性分析。纳入标准包括SFRT（60 Gy/30次分割或59.4 Gy/33次分割）与HRT（40 Gy/15次分割）。
结果
在该队列中，158例患者接受了SFRT，26例接受了HRT。接受SFRT与HRT的患者中位生存期分别为430天和475天（P = 0.550）。95%的SFRT患者接受了TMZ，而接受HRT的患者为100%。接受HRT的患者年龄更大（中位年龄，72岁对66岁）。所有HRT患者均采用调强放疗（IMRT）技术治疗，而SFRT患者中57%采用IMRT。多因素Cox回归显示，患者年龄>70岁（风险比[HR]，1.84）、卡诺夫斯基功能状态较低（HR，5.25）、活检与手术切除（HR，4.18）、放疗计划技术为三维或二维计划与IMRT（HR分别为1.91；HR，3.40）与总生存期（OS）降低相关。仅限于接受基于IMRT计划的患者的分析显示，HRT和SFRT之间的OS无差异。对于接受TMZ的患者，HRT治疗组和SFRT治疗组之间的生存期无差异。
结论
接受HRT和接受SFRT的老年GBM患者的OS相似。接受同步TMZ的亚组分析患者显示，HRT组和SFRT组之间的OS无差异。
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