复发性高级别胶质瘤的再照射：关于生存和放射性坏死风险的治疗技术的系统评价与分析
Re-irradiation for recurrent high-grade gliomas: a systematic review and analysis of treatment technique with respect to survival and risk of radionecrosis.
作者信息
Shanker Mihir, Chua Benjamin, Bettington Catherine, Foote Matthew C, Pinkham Mark B
机构信息
The University of Queensland, Faculty of Medicine, Australia.
Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Australia.
出版信息
Neurooncol Pract. 2019 Mar;6(2):144-155. doi: 10.1093/nop/npy019. Epub 2018 Jun 14.
BACKGROUND
Re-irradiation may be considered for select patients with recurrent high-grade glioma. Treatment techniques include conformal radiotherapy employing conventional fractionation, hypofractionated stereotactic radiotherapy (FSRT), and single-fraction stereotactic radiosurgery (SRS).
METHODS
A pooled, population-weighted, multiple linear regression analysis of publications from 1992 to 2016 was performed to evaluate the relationships between re-irradiation technique and median overall survival (OS) and radionecrosis outcomes.
RESULTS
Seventy published articles were analyzed, yielding a total of 3302 patients. Across all studies, initial treatment was external beam radiotherapy to a median dose of 60 Gy in 30 fractions, with or without concurrent chemotherapy. On multivariate analysis, there was a significant correlation between OS and radiotherapy technique after adjusting for age, re-irradiation biologically equivalent dose (EQD2), interval between initial and repeat radiotherapy, and treatment volume ( < .0001). Adjusted mean OS was 12.2 months (95% CI, 11.8-12.5) after SRS, 10.1 months (95% CI, 9.7-10.5) after FSRT, and 8.9 months (95% CI, 8.4-9.4) after conventional fractionation. There was also a significant association between radionecrosis and treatment technique after adjusting for age, re-irradiation EQD2, interval, and volume ( < .0001). Radionecrosis rate was 7.1% (95% CI, 6.6-7.7) after FSRT, 6.1% (95% CI, 5.6-6.6) after SRS, and 1.1% (95% CI, 0.5-1.7) after conventional fractionation.
CONCLUSIONS
The published literature suggests that OS is highest after re-irradiation using SRS, followed by FSRT and conventionally fractionated radiotherapy. Whether this represents superiority of the treatment technique or an uncontrolled selection bias is uncertain. The risk of radionecrosis was low for all modalities overall. Re-irradiation is a feasible option in appropriately selected patients.
背景
对于部分复发性高级别胶质瘤患者可考虑再次放疗。治疗技术包括采用常规分割的适形放疗、低分割立体定向放疗（FSRT）和单次分割立体定向放射外科治疗（SRS）。
方法
对1992年至2016年发表的文献进行汇总、人口加权的多重线性回归分析，以评估再次放疗技术与中位总生存期（OS）和放射性坏死结局之间的关系。
结果
分析了70篇已发表文章，共纳入3302例患者。在所有研究中，初始治疗为外照射放疗，中位剂量为60 Gy，分30次，联合或不联合同步化疗。多因素分析显示，在调整年龄、再次放疗生物等效剂量（EQD2）、初始放疗与再次放疗间隔时间及治疗体积后，OS与放疗技术之间存在显著相关性（P<0.0001）。SRS后调整后的平均OS为12.2个月（95%CI，11.8 - 12.5），FSRT后为10.1个月（95%CI，9.7 - 10.5），常规分割放疗后为8.9个月（95%CI，8.4 - 9.4）。在调整年龄、再次放疗EQD2、间隔时间和体积后，放射性坏死与治疗技术之间也存在显著关联（P<0.0001）。FSRT后放射性坏死率为7.1%（95%CI，6.6 - 7.7），SRS后为6.1%（95%CI，5.6 - 6.6），常规分割放疗后为1.1%（95%CI，0.5 - 1.7）。
结论
已发表的文献表明，使用SRS再次放疗后的OS最高，其次是FSRT和常规分割放疗。这是代表治疗技术的优越性还是未控制的选择偏倚尚不确定。总体而言，所有治疗方式的放射性坏死风险都较低。对于适当选择的患者，再次放疗是一种可行的选择。
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