Department of Radiation Oncology, Seoul National University College of Medicine, South Korea.
Department of Pathology, Seoul National University College of Medicine, South Korea.
Radiother Oncol. 2018 Aug;128(2):254-259. doi: 10.1016/j.radonc.2018.05.024. Epub 2018 Jun 21.
A majority of high-grade gliomas relapse despite combined surgery, radiotherapy and chemotherapy. There is no consensus on standard treatment for recurrent high-grade gliomas, or defined efficacy of adjuvant re-RT after re-Op. This retrospective study evaluated the benefit and safety of re-RT after re-Op (re-Op/RT).
A total of 84 patients with recurrent high-grade gliomas who underwent reoperation from 2009 to 2015 were analyzed. All patients received neurosurgical intervention and adjuvant radiotherapy previously before recurrence. At recurrence and after reoperation, treatment options were discussed in multidisciplinary clinic or brain tumor joint conference. For re-RT, cumulative EQD (equivalent dose in 2 Gy fractions at α/β = 2) was below 106.9 Gy.
Median progression free survival (PFS) was 6.5 months; 3.5 months with re-Op, 9.0 months with re-Op/RT (p = 0.025). Age <50, time interval to recur ≥12 months, WHO pathologic grade III, methylated MGMT promotor, and re-RT were factors enhancing PFS in the multivariate analysis. Median overall survival (OS) was 18.3 months: 12.7 months with re-Op, and 28.1 months with re-Op/RT (p = 0.066). Three risk factors (age >50, WHO grade IV, and unmethylated promoter of MGMT) were significantly associated with poor OS in multivariate analysis. Benefit of re-RT in both OS and PFS was established in patients carrying 2 or more risk factors. During re-RT, 4 patients (8%) had grade 2 or higher toxicity, and 3 patients (6%) did not complete re-RT. No radionecrosis was observed.
Re-RT after re-Op was tolerable with a cumulative median EQD of 99.3 Gy and resulted in clear benefit in PFS and marginal gain in OS. Survival gain with re-Op/RT was more prominent in patients with two or more risk factors (age ≥50, WHO pathologic grade IV, unmethylated MGMT promoter), and needs to be validated.
尽管进行了联合手术、放疗和化疗，大多数高级别胶质瘤仍会复发。对于复发性高级别胶质瘤，目前尚无标准治疗方法，也没有明确定义再次手术后辅助再放疗（re-Op/RT）的疗效。本回顾性研究评估了再次手术后辅助再放疗（re-Op/RT）的疗效和安全性。
分析了 2009 年至 2015 年期间接受再次手术的 84 例复发性高级别胶质瘤患者。所有患者在复发前均接受过神经外科干预和辅助放疗。在复发时和再次手术后，在多学科诊所或脑肿瘤联合会议上讨论治疗选择。对于再放疗，累积等效剂量（EQD）（α/β=2 时 2 Gy 分数的等效剂量）低于 106.9 Gy。
中位无进展生存期（PFS）为 6.5 个月；再次手术后为 3.5 个月，再次手术后辅助再放疗为 9.0 个月（p=0.025）。年龄<50 岁、复发间隔时间≥12 个月、世界卫生组织（WHO）病理分级 III 级、甲基化 MGMT 启动子和再放疗是多因素分析中延长 PFS 的因素。中位总生存期（OS）为 18.3 个月：再次手术后为 12.7 个月，再次手术后辅助再放疗为 28.1 个月（p=0.066）。多因素分析中，3 个危险因素（年龄>50 岁、WHO 分级 IV 级和 MGMT 启动子未甲基化）与 OS 不良显著相关。在携带 2 个或更多危险因素的患者中，再放疗在 OS 和 PFS 方面均有获益。在再放疗期间，4 名患者（8%）出现 2 级或以上毒性，3 名患者（6%）未完成再放疗。未观察到放射性坏死。
再次手术后辅助再放疗的累积中位 EQD 为 99.3 Gy，可耐受，且 PFS 明显获益，OS 有轻微获益。在具有 2 个或更多危险因素（年龄≥50 岁、WHO 病理分级 IV 级、MGMT 启动子未甲基化）的患者中，再放疗/RT 的生存获益更为显著，尚需进一步验证。
