大剂量放疗可改善新诊断的低级别脑胶质瘤患者的生存。
Association of high-dose radiotherapy with improved survival in patients with newly diagnosed low-grade gliomas.
机构信息
Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
出版信息
Cancer. 2022 Mar 1;128(5):1085-1092. doi: 10.1002/cncr.34028. Epub 2021 Nov 15.
BACKGROUND
The radiation dose for patients with low-grade gliomas (LGGs) is controversial. The objective of this study was to investigate the impact of the radiation dose on survival for patients with LGGs and especially for molecularly defined subgroups.
METHODS
Three hundred fifty-one patients with newly diagnosed LGGs from the multicenter Chinese Glioma Cooperative Group received postoperative radiotherapy (RT) in 2005-2018. The RT dose, as a continuous variable, was entered into a Cox regression model using penalized spline regression to allow for a nonlinear relationship between the RT dose and overall survival (OS) or progression-free survival (PFS). Inverse probability of treatment weighting (IPTW)-adjusted propensity scores were used to correct for potential confounders. Dose effects on survival within IDH mutation and 1p/19q codeletion defined subgroups were analyzed.
RESULTS
The risk of mortality and disease progression decreased sharply until 54 Gy. High-dose RT (≥54 Gy) was associated with significantly better 5-year OS (81.7% vs 64.0%; hazard ratio [HR], 0.33; P < .001) and PFS (77.4% vs 54.5%; HR, 0.46; P < .001) than low-dose RT (<54 Gy). IPTW correction confirmed the associations (HR for OS, 0.44; P = .001; HR for PFS, 0.48; P = .003). High-dose RT was associated with longer PFS (HR, 0.25; P = .002; HR, 0.21; P = .039) and OS (HR, 0.27; P = .006; HR, 0.07; P = .017) in IDH-mutant/1p/19q noncodeleted and IDH wild-type subgroups, respectively. No significant difference in survival was observed with high-dose RT in the IDH-mutant/1p/19q codeleted subgroup.
CONCLUSIONS
High-dose RT (≥54 Gy) was effective in LGGs. Patients with an IDH mutation/1p/19q noncodeletion or IDH wild-type may need to be considered for high-dose RT.
LAY SUMMARY
The radiotherapy dose-response was observed in patients with low-grade gliomas, and high-dose radiotherapy (≥54 Gy) was associated with improved survival. Patients with an IDH mutation/1p/19q noncodeletion or wild-type IDH may have improved survival with the administration of high-dose radiotherapy.
背景
低级别胶质瘤（LGG）患者的放射剂量存在争议。本研究旨在探讨放射剂量对 LGG 患者生存的影响，特别是对分子定义亚组的影响。
方法
2005 年至 2018 年，来自多中心中国神经胶质瘤协作组的 351 例新诊断为 LGG 的患者接受了术后放疗（RT）。RT 剂量作为连续变量，通过惩罚样条回归纳入 Cox 回归模型，以允许 RT 剂量与总生存期（OS）或无进展生存期（PFS）之间存在非线性关系。采用逆概率治疗加权（IPTW）调整倾向评分来校正潜在混杂因素。分析 IDH 突变和 1p/19q 联合缺失定义的亚组内生存的剂量效应。
结果
死亡率和疾病进展风险在 54 Gy 时急剧下降。高剂量 RT（≥54 Gy）与显著更好的 5 年 OS（81.7% vs 64.0%；风险比[HR]，0.33；P<.001）和 PFS（77.4% vs 54.5%；HR，0.46；P<.001）相关，而低剂量 RT（<54 Gy）则不然。IPTW 校正证实了这些关联（OS 的 HR，0.44；P=.001；PFS 的 HR，0.48；P=.003）。高剂量 RT 与 IDH 突变/1p/19q 非联合缺失和 IDH 野生型亚组中更长的 PFS（HR，0.25；P=.002；HR，0.21；P=.039）和 OS（HR，0.27；P=.006；HR，0.07；P=.017）相关。在 IDH 突变/1p/19q 联合缺失亚组中，高剂量 RT 对生存无显著影响。
结论
高剂量 RT（≥54 Gy）对 LGG 有效。IDH 突变/1p/19q 非联合缺失或 IDH 野生型患者可能需要考虑高剂量 RT。
置于
高剂量放疗（≥54 Gy）可改善低级别胶质瘤患者的生存。IDH 突变/1p/19q 非联合缺失或 IDH 野生型患者接受高剂量放疗可能会提高生存率。
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