Khalil Toufic, Lemaire Jean Jacques, Dedieu Véronique, Donnarieix Denise, Béatrice Claise, Lapeyre Michel, Kemeny Jean Louis, Pereira Bruno, Thalami Aurélie, Chazal Jean, Verrelle Pierre
Service de neurochirurgie A, CHU Gabriel Montpied, 63 000 Clermont-Ferrand, France.
Département de Radiothérapie, Centre Jean Perrin, 63 000 Clermont-Ferrand, France.
J Radiosurg SBRT. 2013;2(4):291-305.
The place of radiosurgery (RS) as an option in the treatment of recurrent malignant glioma is still debated on in the absence of prospective randomized trials.
To assess the clinical outcome and MRI response after radiosurgery of recurrent malignant glioma.
We evaluated 50 consecutive patients treated in a single institution. Between 2001 and 2008, 34 glioblastoma (GBM) and 16 anaplastic oligodendroglioma (AO) patients were treated with linear accelerator (Linac) RS for recurrence.
The median marginal dose was 15 Gy and the median gross tumor volume (GTV) was 6.64 ml. No patient had acute (< 3 months) neurological morbidity after RS. Ten patients (20%) were reoperated on after RS, histopathological findings included necrosis alone in 3 cases (6%). The median overall survival was 21.5 months for GBM and 57.9 months for AO. The median survival after RS was 9.5 months for GBM and 32.9 months for AO. The median progression-free survival after RS was 6.7 months for GBM and 18 months for AO. MRI volume modifications after RS showed a transitory reduction or stabilization of disease linked to significantly improved survival in 58.8% of patients with GBM, 81.1% of patients with AO. Pathological subtype (AO versus GBM), MRI response, KPS >70, marginal dose > 13 Gy, largest diameter of GTV < 25 mm and GTV < 7 ml were the main prognostic factors, associated with improved survival or PFS from RS.
The magnitude of the survival increase compared to historical RPA classes may not be due to selection bias alone. Linac RS in selected patients with recurrent malignant glioma was well tolerated, effective and can be considered as one of several re-treatment options.
在缺乏前瞻性随机试验的情况下，放射外科（RS）作为复发性恶性胶质瘤治疗选择的地位仍存在争议。
评估复发性恶性胶质瘤放射外科治疗后的临床结局和MRI反应。
我们评估了在单一机构接受治疗的50例连续患者。2001年至2008年期间，34例胶质母细胞瘤（GBM）和16例间变性少突胶质细胞瘤（AO）患者因复发接受直线加速器（Linac）RS治疗。
中位边缘剂量为15 Gy，中位肿瘤总体积（GTV）为6.64 ml。放射外科治疗后无患者发生急性（<3个月）神经功能障碍。10例患者（20%）在放射外科治疗后接受了再次手术，组织病理学结果显示3例（6%）仅为坏死。GBM患者的中位总生存期为21.5个月，AO患者为57.9个月。放射外科治疗后的中位生存期，GBM患者为9.5个月，AO患者为32.9个月。放射外科治疗后的中位无进展生存期，GBM患者为6.7个月，AO患者为18个月。放射外科治疗后MRI体积变化显示，58.8%的GBM患者和81.1%的AO患者疾病出现短暂缩小或稳定，与生存期显著改善相关。病理亚型（AO与GBM）、MRI反应、KPS>70、边缘剂量>13 Gy、GTV最大直径<25 mm以及GTV<7 ml是主要的预后因素，与放射外科治疗后生存期或无进展生存期改善相关。
与历史RPA分级相比，生存期增加的幅度可能不仅仅是由于选择偏倚。在选定的复发性恶性胶质瘤患者中，直线加速器放射外科治疗耐受性良好、有效，可被视为几种再治疗选择之一。
