Yasuda Takayuki, Muragaki Yoshihiro, Nitta Masayuki, Miyamoto Kazunari, Oura Yuko, Henmi Takuo, Noguchi Sanshiro, Oda Hideaki, Saito Taiichi, Maruyama Takashi, Atsuchi Shoko, Miura Naohisa, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Faculty of Advanced Techno-Surgery, Institute of Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
World Neurosurg. 2018 Jun;114:e1138-e1146. doi: 10.1016/j.wneu.2018.03.161. Epub 2018 Mar 31.
This study aimed to evaluate the efficacy of stereotactic radiotherapy combined with bevacizumab (SRT-Bv) compared with Bv treatment for recurrent high-grade gliomas (HGGs).
Data for patients with recurrent HGGs who received SRT and Bv (n = 29) or Bv (n = 29) between June 2014 and September 2016 were retrospectively analyzed. All patients received conventional radiotherapy (total, 60 Gy) before this study. SRT was administered at a median dose of 42 Gy in 3-7 fractions. The recurrence pattern was classified into 3 groups: in-field, marginal, and out-field.
The median overall survival in the SRT-Bv group was significantly longer than that in the Bv group (10.4 vs. 5.6 months; P = 0.02). In patients with isocitrate dehydrogenase wild-type tumors, the SRT-Bv treatment significantly prolonged survival more than the Bv treatment (10.9 vs. 8.2 months; P = 0.01). The World Health Organization grade and presence or absence of SRT were significant prognostic factors in the univariate analysis. Besides brain edema in 2 cases and asymptomatic subdural hematoma in 1 case, no other severe adverse effect due to SRT-Bv treatment was recorded. The pattern of recurrence was as follows: in-field, 2 cases (7%); marginal, 8 cases (28%); out-field, 11 cases (38%); no recurrence on radiologic findings, 6 cases (21%); and uncertain, 2 cases (7%).
SRT-Bv treatment significantly prolonged survival duration more than Bv treatment and provides good local control in patients with recurrent HGGs, especially those with isocitrate dehydrogenase wild-type tumors.
本研究旨在评估立体定向放射治疗联合贝伐单抗（SRT-Bv）与单纯贝伐单抗（Bv）治疗复发性高级别胶质瘤（HGG）的疗效。
回顾性分析2014年6月至2016年9月期间接受SRT联合Bv（n = 29）或单纯Bv（n = 29）治疗的复发性HGG患者的数据。所有患者在本研究之前均接受了常规放疗（总量60 Gy）。SRT的中位剂量为42 Gy，分3 - 7次给予。复发模式分为3组：野内复发、边缘复发和野外复发。
SRT-Bv组的中位总生存期显著长于Bv组（10.4个月对5.6个月；P = 0.02）。在异柠檬酸脱氢酶野生型肿瘤患者中，SRT-Bv治疗比Bv治疗显著延长生存期（10.9个月对8.2个月；P = 0.01）。在单因素分析中，世界卫生组织分级和是否接受SRT是显著的预后因素。除2例出现脑水肿和1例无症状硬膜下血肿外，未记录到其他因SRT-Bv治疗导致的严重不良反应。复发模式如下：野内复发2例（7%）；边缘复发8例（28%）；野外复发11例（38%）；影像学检查无复发6例（21%）；情况不明2例（7%）。
SRT-Bv治疗比Bv治疗显著延长了生存期，并为复发性HGG患者提供了良好的局部控制，尤其是异柠檬酸脱氢酶野生型肿瘤患者。
