Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurosurgery, CHA Bundang Medical Center, School of Medicine, CHA University, Bundang, Korea.
Sci Rep. 2018 Jan 15;8(1):777. doi: 10.1038/s41598-017-19014-1.
We assessed the appropriateness of current radiotherapy volume for WHO grade III gliomas. The records of 73 patients with WHO grade III gliomas who received postoperative radiotherapy between 2001 and 2013 were retrospectively reviewed. Based on the 2016 WHO classification, 25/73 (34.2%) patients had anaplastic oligodendroglioma (AO), IDH-mutant and 1p/19q-codeleted; 11/73 (15.1%) patients had anaplastic astrocytoma, IDH-mutant; and 37/73 (50.7%) patients had anaplastic astrocytoma, IDH-wildtype. The extent of resection (EOR) was total in 43 patients (58.9%). The median follow-up time was 84 months. The 5-year overall survival was 65.4%. Of 31 patients with documented recurrences, 20 (64.5%) had infield gross tumor volume (GTV) failure, six (19.4%) had clinical target volume (CTV)/marginal failure, and five (16.1%) had outfield failure/seeding. In 13 recurrences among 43 patients who underwent gross total resection (GTR), six (46.2%) had infield CTV/marginal failure. However, among 30 patients for whom GTR was not conducted, infield GTV failure was dominant (77.8%). Seventeen patients with AO, IDH-mutant and 1p/19q-codeleted who underwent GTR experienced no recurrence. In conclusion, maximal surgical resection and postoperative radiotherapy resulted in a favorable prognosis, especially in patients with GTR, IDH mutation, and 1p/19q codeletion. Patterns of failure differed by EOR.
我们评估了当前放射治疗体积对世界卫生组织（WHO）三级胶质瘤的适宜性。回顾性分析了 2001 年至 2013 年间接受术后放疗的 73 例 WHO 三级胶质瘤患者的病历。根据 2016 年 WHO 分类，25/73（34.2%）例患者为间变性少突胶质细胞瘤（AO），IDH 突变，1p/19q 共缺失；11/73（15.1%）例患者为间变性星形细胞瘤，IDH 突变；37/73（50.7%）例患者为间变性星形细胞瘤，IDH 野生型。43 例患者（58.9%）的切除程度（EOR）为全切除。中位随访时间为 84 个月。5 年总生存率为 65.4%。在有记录的 31 例复发患者中，20 例（64.5%）为瘤床内大体肿瘤体积（GTV）失败，6 例（19.4%）为临床靶区（CTV）/边缘失败，5 例（16.1%）为野外失败/播种。在 43 例接受完全切除（GTR）的患者中，有 13 例复发，其中 6 例（46.2%）为瘤床内 CTV/边缘失败。然而，在未进行 GTR 的 30 例患者中，瘤床 GTV 失败更为常见（77.8%）。17 例 AO，IDH 突变和 1p/19q 共缺失患者接受 GTR 后无复发。总之，最大程度的手术切除和术后放疗可带来良好的预后，特别是在 GTR、IDH 突变和 1p/19q 缺失的患者中。EOR 不同，失败模式也不同。
