伽玛刀放射外科治疗高级别脑胶质瘤：中国单中心六年经验。

Gamma Knife Radiosurgery for High-Grade Gliomas: Single-Center Experience of Six Years in China.

机构信息

Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,

Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.

出版信息

Stereotact Funct Neurosurg. 2021;99(3):181-186. doi: 10.1159/000509782. Epub 2021 Mar 23.

DOI:10.1159/000509782

PMID:33756470

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

GKRS can be used to effectively treat malignant brain glioma and can therefore be used as an alternative treatment option.

摘要

目的

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。

方法

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。

结果

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）。