Byrne Emma, Abel Stephen, Yu Alexander, Shepard Matthew, Karlovits Stephen M, Wegner Rodney E
Drexel University College of Medicine, Philadelphia, PA, USA.
Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
J Neurooncol. 2022 Mar;157(1):197-205. doi: 10.1007/s11060-022-03962-4. Epub 2022 Feb 23.
Adjuvant radiation is often used in patients with low grade gliomas with high-risk characteristics with a recommended dose of 45-54 Gy. We used the National Cancer Database (NCDB) to see which doses were being used, and if any difference was seen in outcome.
We queried the NCDB for patients with WHO Grade 2 primary brain tumors treated with surgery and adjuvant radiotherapy. We divided the cohort into dose groups: 45-50 Gy, 50.4-54 Gy, and > 54 Gy. Multivariable logistic regression was used to identify predictors of low and high dose radiation. Propensity matching was used to account for indication bias.
We identified 1437 patients meeting inclusion criteria. Median age was 45 years and 62% of patients were > 40 years old. Nearly half of patients (48%) had astrocytoma subtype and 70% had subtotal resection. The majority of patients (69%) were treated to doses between 50.4 and 54 Gy. Predictors of high dose radiation (> 54 Gy) were increased income, astrocytoma subtype, chemotherapy receipt, and treatment in later year (2014). The main predictors of survival were age > 40, astrocytoma subtype, and insurance type. Patients treated to a dose of > 54 Gy had a median survival of 73.5 months and was not reached in those treated to a lower dose (p = 0.0041).
This analysis shows that 50.4-54 Gy is the most widely used radiation regimen for the adjuvant treatment of low-grade gliomas. There appeared to be no benefit to higher doses, although unreported factors may impact interpretation of the results.
辅助放疗常用于具有高危特征的低级别胶质瘤患者，推荐剂量为45 - 54Gy。我们利用国家癌症数据库（NCDB）来了解实际使用的剂量以及疗效是否存在差异。
我们在NCDB中查询接受手术和辅助放疗的WHO 2级原发性脑肿瘤患者。我们将队列分为剂量组：45 - 50Gy、50.4 - 54Gy和＞54Gy。采用多变量逻辑回归来确定低剂量和高剂量放疗的预测因素。使用倾向匹配法来处理指征偏倚。
我们确定了1437例符合纳入标准的患者。中位年龄为45岁，62%的患者年龄＞40岁。近一半的患者（48%）为星形细胞瘤亚型，70%的患者进行了次全切除。大多数患者（69%）接受的剂量在50.4至54Gy之间。高剂量放疗（＞54Gy）的预测因素包括收入增加、星形细胞瘤亚型、接受化疗以及在较晚年份（2014年）接受治疗。生存的主要预测因素是年龄＞四十岁、星形细胞瘤亚型和保险类型。接受＞54Gy剂量治疗的患者中位生存期为73.5个月，而接受较低剂量治疗的患者未达到此生存期（p = 0.0041）。
该分析表明，50.4 - 54Gy是低级别胶质瘤辅助治疗中使用最广泛的放疗方案。高剂量放疗似乎没有益处，尽管未报告的因素可能会影响对结果的解释。
