Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,
Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
Stereotact Funct Neurosurg. 2021;99(3):181-186. doi: 10.1159/000509782. Epub 2021 Mar 23.
The aim of this study was to evaluate the efficacy of Gamma Knife radiosurgery (GKRS) as a salvage therapy for high-grade glioma in our center.
A total of 167 patients with malignant glioma were treated with GKRS in our Gamma Knife Center between January 2013 and December 2017; 140 patients (85 males and 55 females) were followed up and enrolled in our study. A single lesion was found in 110 cases, and multiple lesions were found in 30 cases; 108 cases received a single therapy, and in 32 cases, at least 2 GKRSs were performed. The median tumor volume was 13.5 cm3. The mean radiation dosage was 14.35 Gy (range, 6-18 Gy). MRI was performed regularly. The RANO criteria and Cox analysis were used to evaluate the therapeutic efficiency.
Follow-up MRI showed the local control rate was 61.4% at 3 months after GKRS, 25.0% at 6 months, and 7.1% at 12 months. The mean and median progression-free survival (PFS) periods were 8.6 (95% CI, 6.3-11.0) and 4 (95% CI, 3.5-4.5) (range, 1-60) months, respectively. The overall survival (OS) after GKRS was 3-62 months, with a mean of 16.7 (95% CI, 14.6-18.9) months, and the median survival was 13 (95% CI, 12.1-13.9) months. The 1-, 2-, and 5-year survival rates were 51.4, 10.0, and 2.9%, respectively. No severe complications occurred. Cox regression showed that glioma pathology was closely related to prognosis (p < 0.05). The Karnofsky Performance Score had little influence on PFS (p > 0.05) but influenced OS significantly (p < 0.05).
GKRS can be used to effectively treat malignant brain glioma and can therefore be used as an alternative treatment option.
本研究旨在评估我院采用伽玛刀放射外科（GKRS）治疗高级别脑胶质瘤的疗效。
2013 年 1 月至 2017 年 12 月期间，我院伽玛刀中心对 167 例恶性胶质瘤患者进行了 GKRS 治疗，随访并纳入本研究的患者共 140 例，其中男性 85 例，女性 55 例。单发肿瘤 110 例，多发肿瘤 30 例。单纯治疗 108 例，2 次以上 GKRS 治疗 32 例。肿瘤中位体积为 13.5cm3，中位照射剂量为 14.35Gy（范围 6-18Gy）。定期行 MRI 检查。采用 RANO 标准和 Cox 分析评估治疗效果。
随访 MRI 显示，GKRS 后 3 个月局部控制率为 61.4%，6 个月为 25.0%，12 个月为 7.1%。中位无进展生存期（PFS）和平均 PFS 分别为 8.6（95%CI：6.3-11.0）和 8.6（95%CI：6.3-11.0）个月（范围 1-60 个月）。GKRS 后总生存期（OS）为 3-62 个月，平均 16.7（95%CI：14.6-18.9）个月，中位 OS 为 13（95%CI：12.1-13.9）个月。1、2、5 年生存率分别为 51.4%、10.0%和 2.9%。无严重并发症发生。Cox 回归分析显示，胶质瘤病理与预后密切相关（p<0.05）。卡氏行为状态评分对 PFS 的影响较小（p>0.05），但对 OS 影响显著（p<0.05）。
GKRS 可有效治疗恶性脑胶质瘤，可作为治疗的一种选择。
