Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan.
Department of Neurosurgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure City, Hiroshima, 737-0023, Japan.
J Neurooncol. 2022 Sep;159(3):531-538. doi: 10.1007/s11060-022-04090-9. Epub 2022 Aug 3.
The so-called radiation-induced glioma (RIG, a secondary glioma after cranial irradiation), is a serious late effect after cranial radiation therapy. The clinical characteristics of and ideal treatment for these tumors are unclear. We analyzed our case series and conducted a comprehensive literature review to reveal the precise characteristics of RIGs.
We analyzed the cases of six patients with RIGs treated at our institution and 354 patients with RIGs from the literature. The latency period from irradiation to the development of each RIG and the median overall survival of the patients were subjected to Kaplan-Meier analyses. Spearman's correlation test was used to determine the relationship between age at irradiation and the latency period.
The mean age of the 360 patients at the development of RIG was 27.42 ± 17.87 years. The mean latency period was 11.35 ± 8.58 years. Multiple gliomas were observed in 28.4%. WHO grade 3 and 4 RIGs accounted for 93.3%. The latency periods were significant shorter in the higher WHO grade group (p = 0.0366) and the concomitant systemic chemotherapy group (p < 0.0001). Age at irradiation was negatively associated with the latency period (r =- 0.2287, p = 0.0219). The patients treated with radiotherapy achieved significantly longer survival compared to those treated without radiotherapy (p = 0.0011).
Development in younger age, multiplicity, and high incidence of grade 3 and 4 are the clinical characteristics of RIGs. Cranial irradiation at older ages and concomitant chemotherapy were associated with shorter latency for the development of RIG. Radiation therapy may be the feasible treatment option despite radiation-induced gliomas.
所谓的放射性脑胶质瘤（RIG，颅脑放疗后的继发性脑胶质瘤）是颅脑放疗后严重的迟发性并发症。这些肿瘤的临床特征和理想治疗方法尚不清楚。我们分析了我们的病例系列，并进行了全面的文献复习，以揭示 RIG 的精确特征。
我们分析了在我们机构治疗的 6 例 RIG 患者的病例，并对文献中的 354 例 RIG 患者进行了分析。采用 Kaplan-Meier 分析法对每位 RIG 患者从放疗到发病的潜伏期和患者的中位总生存期进行分析。采用 Spearman 相关检验来确定放疗年龄与潜伏期之间的关系。
360 例 RIG 患者的平均发病年龄为 27.42±17.87 岁。平均潜伏期为 11.35±8.58 年。28.4%的患者发生多发性脑胶质瘤。WHO 分级 3 级和 4 级 RIG 占 93.3%。WHO 分级较高组（p=0.0366）和同时进行全身化疗组（p<0.0001）的潜伏期明显缩短。放疗年龄与潜伏期呈负相关（r=-0.2287，p=0.0219）。接受放疗的患者的生存时间明显长于未接受放疗的患者（p=0.0011）。
发病年龄较小、多发性、高级别是 RIG 的临床特征。高龄放疗和同时进行化疗与 RIG 潜伏期缩短有关。尽管存在放射性脑胶质瘤，放疗可能是可行的治疗选择。
